
Glass. 
Book_ 



IMt 



CALENDAR NO. 282 



64th Congress 1 q^^t a m? ( Report 

1st Session J SENATE i No _ 3Q6 



CARE AND TREATMENT OF PERSONS 
AFFLICTED WITH LEPROSY 




REPORT 



COMMITTEE ON PUBLIC HEALTH 

AND NATIONAL QUARANTINE 

UNITED STATES SENATE 



S. 4086 



A BILL TO PROVIDE FOR THE CARE AND TREATMENT OF 

PERSONS AFFLICTED WITH LEPROSY, AND TO 

PREVENT THE SPREAD OF LEPROSY 

IN THE UNITED STATES 




PRESENTED BY MR. RANSDELL 
March 25, 1916.— Ordered to be printed, with illustrations 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1916 



\9 X 



D. of D. 
MAY 8 1916 



I. 



TABLE OF CONTENTS. 



Page. 

Report of committee 1 

Preface 7 

National leprosarium bill 11 

Letter of Hon. W. G. McAdoo, Secretary of the Treasury, in favor 

thereof 12 

Testimony of — 

Dr. Isadore Dyer 13 

Dr. Howard Fox 38 

Dr. Heni-y M. Bracken 48 

Dr. Frank H. Parker 52 

Dr. Martin F. Engman 58 

Dr. J. W. McKean 68 

Mr. W. M. Danner 71 

Dr. John S. Fulton 82 

Dr. Frederick S. Hoffman 85 

Dr. William C. Fowler 143 

Mrs. Wilbur F. Crafts 147 

Dr. W. C. Woodward 151 

Dr. George W. McCoy 160 

Dr. W. C. Rucker 191 

in 



Calendar No. 282. 

64th Congress, | SENATE, j Beport 

1st Session. ) \ No. 306. 



CAKE AND TREATMENT OF PERSONS AFFLICTED WITH 
LEPROSY. 



March 25, 1916. — Ordered to be printed. 



Mr. Ransdell, from the Committee on Public Health and National 
Quarantine, submitted the following 

REPORT. 

[To accompany S. 4086.] 

The Committee on Public Health and National Quarantine, to 
whom was referred the bill (S. 4086) to provide for the care and 
treatment of persons afflicted with leprosy, and to prevent the spread 
of leprosy in the United States, having considered the same, report it 
back favorably with certain amendments, and, as amended, recom- 
mend its passage. 

Strike out section 5, on page 3, and insert in lieu thereof the fol- 
lowing : 

Sec. 5. That when any commissioned or other officer of the Public Health 
Service is detailed for duty at the home herein provided for, he shall receive in 
addition to the pay and allowance of his gi'ade one-quarter of the pay of said 
grade. 

The bill, as proposed to be amended by your committee, is as fol- 
lows : 

[S. 4086 Sixty-fourth Congress, first session.] 

A BILL To provide for the care and treatment of persons afflicted with leprosy and to 
prevent the spread of leprosy in the United States. 

Be it enacted by the Senate and House of Representatives of the United States 
of America in Congress assembled, That for the purpose of carrying out the 
provisions of this act the Secretary of the Treasury is authorized to select and 
obtain, by purchase or otherwise, a site suitable for the establishment of a 
home for the care and treatment of persons afflicted with leprosy, to be admin- 
istered by the United States Public Health Service ; and either the Secretary of 
War, the Secretary of the Navy, the Secretary of the Interior, of the Secretary 
of Agriculture is authorized to transfer to the Secretary of the Treasury any 
abandoned military, naval, or other reservation suitable for the purpose, or as 
much thereof as may be necessary, with all buildings and improvements thereon, 
to be used for the purpose of said home or homes. 

Sec 2. That there shall be received into said home, under regulations pre- 
pared by the Surgeon General of the Public Health Service, with the approval 
of the Secretary of the Treasury, any person afflicted with leprosy who pre- 



2 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

sents himself or herself for care, detention, and treatment, or who may be 
apprehended under authority of the United States quarantine acts, or any 
person afflicted with leprosy duly consigned to said home by the proper health 
authorities of any State, Territory, or the District of Columbia. The Surgeon 
General of the Public Health Service is authorized, upon request of said 
authorities, to send for any person afflicted with leprosy within their respective 
jurisdictions, and to convey said person to such home for detention and treat- 
ment, and when the transportation of any such person is undertaken for the 
protection of the public health, the expense of such removal shall be paid from 
funds set aside for the maintenance of said home or homes. 

Sec. 3. That regulations shall be prepared by the Surgeon General of the 
Public Health Service, with the approval of the Secretary of the Treasury, 
for the government and administration of said home and for the apprehension, 
detention, treatment, and release of all persons who are inmates thereof. 

Sec. 4. That the Secretary of the Treasury be, and he is hereby, authorized 
to cause the erection upon such site of suitable and necessary buildings for the 
purposes of this act at a cost not to exceed the sum herein appropriated for 
such purposes. 

Sec. 5. That when any commissioned or other officer of the Public Health 
Service is detailed for duty at the home herein provided for he shall receive 
in addition to the pay and allowances of his grade one quarter of the pay of 
said grade. 

Sec. 6. That for the purpose of carrying out the provisions of this act there 
is hereby appropriated, from any money in the Treasury not otherwise appro- 
priated, the sum of $250,000, or as much thereof as may be necessary, for 
the preparation of said home, including the erection of necessary buildings, 
the maintenance of the patients, pay and maintenance of necessary officers and 
employees, until June thirtieth, nineteen hundred and seventeen. 

The committee is of the opinion that for the protection of the 
public health, the humanitarian treatment of persons afflicted with 
leprosy, and the furtherance of the scientific study and investigation 
of the disease, Congress should provide a home or homes for the 
care and treatment of persons afflicted with leprosy. At the hear- 
ing which was held by the committee it was shown by the testimony 
of competent expert witnesses that leprosy exists in practically every 
State in the Union; that the disease has been present in the United 
States for a considerable number of years; and that it is on the in- 
crease. It was further shown that the treatment which is at present 
accorded to lepers by the general public is in many instances most 
inhumane and cruel, and that there exists in the United States only 
three institutions which are maintained solely for the purpose of 
treating lepers. The experts before mentioned, many of whom have 
devoted many years to the careful study of the disease, were unani- 
mous in stating that the only known means for effectively controlling 
the spread of leprosy is segregation. Many of the lepers in the 
United States wander about the country seeking an asylum, and in 
this way they engage in interstate travel, and hence fall within the 
jurisdiction of the Federal Government. The}^ frequently have no 
place of legal residence, and it is therefore impossible to decide which 
State shall be responsible for their care and treatment. As a result 
those States w T hich maintain leprosaria have placed upon them the 
burden of taxation for the care of lepers who are not legal residents 
within their jurisdiction. 

It was clearly shown by the testimony which was given at the 
hearings that the incubation period of leprosy is very long, sometimes 
as many as 30 years elapsing between exposure to the disease and the 
development of symptoms. It therefore follows that it is exceedingly 
difficult to remand these prospective lepers at ports of entry. On ac- 
count of the insular possessions of the United States and the closer 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 3 

commercial relations existing between the United States and those 
countries in which leprosy is prevalent, the importation of the disease 
is very apt to occur. In addition to this, American citizens are con- 
stantly going abroad and residing for variable periods of time in 
places in which leprosy exists, and in many cases which were brought 
to the attention of the committee it was clearly shown that leprosy 
had in this way been contracted and subsequently imported into the 
United States. 

Leprosy is a communicable, loathsome, mutilating, chronic disease. 
At the present time, because of the public fear of leprosy and the in- 
adequate accommodations for the care and treatment of those suffer- 
ing therewith, it is exceedingly difficult to state the number of persons 
in the United States suffering with this disease. The estimates given 
at the hearing varied from 500 to 2,500. The experts who testified be- 
fore the committee were of the opinion that if the lepers in the United 
States were segregated at the present time, the further spread of the 
disease would be completely controlled and the problem reduced to 
insignificant proportions in a relatively short space of time. It was 
shown that in other countries the establishment of national leprosaria 
had effectively eradicated leprosy. 

The hearings on this bill, with photographs, are annexed hereto, 
and made a part of this report. 

In view of the foregoing, the committee therefore recommends that 
the bill be passed. 



HEARINGS 



THE COMMITTEE ON PUBLIC HEALTH AND NATIONAL QUARANTINE 
UNITED STATES SENATE, SIXTY-FOURTH CONGRESS, FIRST SES- 
SION, ON S. 4086, A BILL TO PROVIDE FOR THE CARE AND 
TREATMENT OF PERSONS AFFLICTED WITH LEPROSY 
AND TO PREVENT THE SPREAD OF LEPROSY 
IN THE UNITED STATES 



COMMITTEE. 

JOSEPH E. RANSDELL, Louisiana, Chairman. 
DUNCAN U. FLETCHER, Florida. REED SMOOT, Utah. 

ROBERT L. OWEN, Oklahoma JOHN D. WORKS, California. 

CHARLES A. CULBERSON, Texas. JAMES H. BRADY, Idaho. 

J. C. W. BECKHAM, Kentucky. JOHN W. WEEKS, Massachusetts. 

OSCAR W. UNDERWOOD, Alabama. CHARLES E. TOWNSEND, Michigan. 

Rufus W. Fontenot, Clerk 

Jos. M. Rault, Assistant Clerk. 

6 



PREFACE. 

The following pages contain the testimony given at a hearing held 
by the Committee on Public Health and National Quarantine of the 
Senate on February 15 and 16, 1916, on the bill (S. 4086) to provide 
for the care and treatment of persons afflicted with leprosy, and to 
prevent the spread of leprosy in the United States. 

The testimony here recorded was given by physicians of national 
and international reputation, by missionaries, by sanitarians, and oth- 
ers conversant with the distribution and spread of the disease which 
has been so long the scourge of the human race that its history loses 
itself in the mists of antiquity. 

The evidence clearly shows that leprosy is a chronic mutilating 
disease, whose victims inspire such a horror in the public mind that 
they are ostracized, harried from place to place, at times being- 
locked up like common criminals, and at others undergoing treat- 
ment which for refinement of cruelty is worse than death itself. It 
is brought forth clearly that the disease is widespread in the United 
States to an extent that is little realized. Some of the witnesses testi- 
fied that the disease is on the increase, and all agreed in the statement 
that segregation is the only effective means for the eradication and 
prevention of leprosy. The witnesses also unite in agreeing that on 
humanitarian and economic grounds the only way in which to attack 
the leprosy problem in the United States is through the erection and 
maintenance of a national home for lepers. Not only is this the most 
humane way in which the unfortunate sufferers from a loathsome 
communicable disease may be treated, but it is also the most economi- 
cal, because the overhead costs of caring for 100 lepers is not very 
much greater than the overhead cost for caring for 20 lepers. All of 
the State health officers are in favor of the bill, and it has the official 
indorsement of the American Dermatological Association, the Ameri- 
can Medical Association, the American Academy of Medicine, and the 
conference of State and Territorial health authorities. 

The incubation period of leprosy is very long, sometimes as many 
as 30 years elapsing between exposure to the disease and the develop- 
ment of symptoms. It is, therefore, practically impossible for the 
United States to exclude cases at quarantine unless they are in the 
active stage of the disease. As a result our people are going abroad, 
particularly to the Orient, becoming infected, returning home, and 
developing the disease many years afterwards. This is particularly 
shown with regard to soldiers who have served in the Philippines. 

Communities are, as a rule, absolutely unprovided with proper 
means for the care, segregation, and isolation of lepers. At the pres- 
ent time there exists no national institution for the reception and 
care of lepers in the continental United States. Lepers do not desire 
to escape from well-conducted leper settlements, and there is no 



8 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

danger to surrounding communities from a leper home, provided the 
home is Avell conducted. 

Aside from the cruelties which are now imposed on the poor leper 
himself, scientific men are deprived of a place in our country where 
leprosy may be studied in all of its manifestations, and means for its 
cure and amelioration sought. A national home for lepers would not 
only be a haven of refuge to the diseased person himself but would 
also be a great scientific workshop wherein clinical and laboratory 
workers could focus their energies on the conquest of one of the most 
terrible diseases which afflicts man. 

The evidence which follows brings out the striking fact that lepers 
are constantly engaged in interstate travel, and thereby constitute a 
menace to the public health. In many instances it has seemed well- 
nigh impossible to determine the residence of these lepers, and they 
move from place to place, becoming an economic burden on commu- 
nities on which they have no rightful claim. Since the Federal Gov- 
ernment exercises control over interstate commerce, it is the duty of 
the General Government to see to it that the States take no harm 
through such commerce. In this instance it becomes the duty of the 
Federal Government to see to it that the States take no harm through 
leprosy which is undergoing interstate transportation. 

There is no doubt a constantly increasing tendency b^y physicians 
not to report cases of leprosy which are diagnosed as such. The 
outrageous treatment accorded lepers by a public possessed of a 
leprophobia, the newspaper notoriety which inevitably ensues when- 
ever a case is reported, and the harrowing and frightful experiences 
which lepers are obliged to undergo, have caused physicians to 
seriously object to reporting cases to the health authorities. One 
physician testified that he and his coworkers had agreed, following 
the impression made upon their minds by the harrowing experience 
which one of their cases had undergone, to never again, until proper 
facilities were provided for the humane care of their cases, declare a 
man a leper. If we are to believe the testimony of the experts who 
have appeared before us this will inevitably tend to further increase 
the number of cases of leprosy. Those who are familiar with the 
leprosy situation in the United States undoubtedly realize that even 
at present this unwillingness to report instances of infection by 
physicians and health organizations is in part responsible for the 
spread of the disease. 

The testimony of the medical witnesses summoned before us goes 
to prove that we must rely upon segregation and isolation of those 
afflicted for protection against this disease. Unfortunately the sci- 
entific world is as yet ignorant of the means of transmission from 
individual to individual. "Whether the conveyer of the infection is 
a blood-sucking insect, or whether the organisms are introudced into 
the system in some manner by inoculation, is quite unknown. 
Theories have been advanced again and again, in each instance either 
to be discarded or merely to be retained as a theory after every 
means of establishing proof has been exhausted. The brightest medi- 
cal minds of centuries have grappled with the problem, but in vain. 
It is true that advances have been made, and Ave should not forget 
that we owe to Xansen the discovery of the bacillus, and to one of 
our own Americans, Clegg, the honor of having first grown the 



FREFACE. • 9 

organisms in artificial media, each of these accomplishments being 
a long step toward establishing a cure. But until the day arrives, 
and there is no doubt in the minds of many that the time will soon 
come, when we can protect the public by curing the individual, we 
must altogether rely upon segregation as a prophylactic measure. 

It is fortunate, indeed, that in segregation we have a method of 
protection which, if utilized, is wholly sufficient to prevent the dis- 
semination of the disease. There can be no doubt on this point. Not 
only have we the testimony of the experts who appeared, but the his- 
torical facts themselves warrant that conclusion. Wherever segre- 
gation has been thoroughly tried, irrespective of the amount of in- 
fection present when instituted, it has resulted in a diminution, if 
not a total eradication, of the disease. Europe was freed of the in- 
fection in the Middle Ages through segregation alone, and our own 
results in the Hawaiian Islands and the Philippines clearly indicate 
that in time these areas, which previously have been hotbeds of the 
infection, will be entirely freed from the disease. If such results can 
be obtained in districts where the disease has been rampant, it is 
reasonable to conclude that by the adoption of similar preventive 
measures the infection can be eradicated from the entire Nation. 

Leprosy was known to the world long before the Christian era. 
In the ancient writings of the Chinese, Syrians, and Egyptians there 
are allusions to a fatal, disfiguring affection which we are warranted 
in assuming was the same as the dreaded scourge of to-day. 
Throughout the east the disease was rampant. At the dme of Christ 
the cry of " unclean " was as familiar to the ears of the multitude as 
is the most common word of warning in our language of to-day. 
The edicts of earlier years, "All the clays wherein the plague shall 
be in him he shall be defiled ; he is unclean ; he shall dwell alone ; with- 
out the camp shall his habitation be " prevailed, and the mutilated 
forms of the afflicted huddled about the gates of every city of Pales- 
tine. 

The earlier Greeks knew little of leprosy. Hippocrates, in whom 
fie medical wisdom of the ages seems to have centered, barely men- 
tions it in his writings, and to him it must have been a rare and 
exotic affection. Aristotle, however, described it vividly. It is, 
therefore, a reasonable conclusion, unless we are willing to accord 
to Aristotle greater discernment in medical matters than we grant to 
Hippocrates, that some time during the half century which existed 
between the lives of these two men, the disease became of sufficient 
importance to attract the attention of the sages of that age. From 
that time, nearly four centuries before Christ, down to the present 
day, the infection has been indigenous to the soil of Greece. 

It was not until the Roman Empire was at its height, following 
the conquest of foreign lands, that the disease was introduced into 
Italy, but from there it spread over all Europe. It was present 
throughout Spain and France when the Moors swept up from the 
south and it had become a common and familiar affliction in England 
even before the Norman conquest. During the Middle Ages no coun- 
try of Europe escaped the disease.- With plague and smallpox it 
constituted the most fearful scourge of mediaeval times, until rulers 
and clergy becoming alarmed at its rapid extension and terrible 
ravages, instituted measures for its control. The repressive measures 



10 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

of that day, while not altogether based on humane principles, rec- 
ognized that the disease was communicable and called for the segre- 
gation and isolation of those afflicted. So widely disseminated was 
the infection that every considerable town had its institution or 
hospital in which the victims were segregated. In England the 
first of these was erected at Canterbury in 1096, and throughout 
Europe there was probably a total of at least 20,000 leprosaria of 
this character. Wherever such means were adopted for its control 
a marked reduction in the incidence of the disease ensued, until 
finally only the records of earlier days remained to tell the story of 
its ravages. There still linger in Norway and along the shores of 
the Baltic, however, foci of infection dating presumably from that 
time, although these are being rapidly extinguished through com- 
pulsory segregation. For a hundred years the disease has been 
nonexistent in England, outside of the relatively few cases develop- 
ing on foreign soil, and Germany, France, and to a certain extent 
Spain, have been equally successful in eradicating the last traces of 
the infection. 

It is uncertain when leprosy invaded the Western Hemisphere. 
Possibly it was brought by the early Spaniards, or it may have been 
introduced from Africa in the days of the slave trade; at any rate 
there is no mention of the disease in the early historical writings. 
At present, however, it occurs sporadically in many sections. Mexico, 
Brazil, Colombia, Venezuela, Chile, and Peru all report cases. 
Countries with such contrasted climatic conditions as Iceland and 
the Hawaiian Islands have been visited and in each instance the 
disease has spread. Though the infection probably reached the 
islands of the Hawaiian group about 1848, opinion seems to differ 
somewhat. In 1865 approximately 1 of every 300 of the native in- 
habitants was affected; by 1891 this proportion had increased to 1 
in 30, since which time, following the institution of repressive meas- 
ures, a rapid diminution in the number of cases has been observed. 

At present, with the exception of the areas mentioned, the disease 
is practically world-wide. It is common enough in the Philippines, 
Japan, the Malay Peninsula, China, India, and Africa, and the resi- 
dents of no climate are exempt. It has greatly increased in South 
Africa, and has attacked Europeans as well as natives. In Australia 
it was introduced by the Chinese, but has in no respect confined its 
ravages to that class. It is safe to say that no particular portion of 
any population possesses immunity, and there is none in whom the 
disease may not occur. Whether they live on mountain or plain, at 
the coast, or in the interior, matters little ; once the infection has been 
introduced it usually spreads. While the degree of communicability 
may not be as great as was formerly supposed, and the length of ex- 
posure must probably be long continued, there is not the slightest 
reason to doubt that every case must arise from a preexisting case. 
The truth of this statement is borne out by the fact that wherever 
segregation and isolation have been practiced a decided reduction 
in the number of cases has been the result. 

Jos. E. Kansdell, Chairman. 



CARE AND TREATMENT OF PERSONS AFFLICTED WITH 
LEPROSY. 



TUESDAY, FEBRUARY 15, 1916. 

United States Senate, 
Committee on Public Health and 

National Quarantine, 

Washington, D. C. 
The committee met in Room 349, Senate Office Building, at 10 
o'clock a. m., pursuant to call, Senator Joseph E. Ransdell presiding. 
Present : Senators Ransdell (chairman) , Fletcher, Beckham, Smoot, 
Works, and Weeks. 

The Chairman. We are convened this morning to hear testimony 
on the bill (S. 4086) to provide for the care and treatment of persons 
afflicted with leprosy and to prevent the spread of leprosy in the 
United States. 

The clerk will cause the bill and the report of the Secretary of the 
Treasury to be inserted in the record. 

[S. 4086, Sixty-fourth Congress, first session.] 

A BILL To provide for the care and treatment of persons afflicted with leprosy and to pre- 
vent the spread of leprosy in the United States. 

Be it enacted by the Senate and House of Representatives of the United States 
of America in Congress assembled, That for the purpose of carrying out the pro- 
visions of this act the Secretary of the Treasury is authorized to select and 
obtain, by purchase or otherwise, a site suitable for the establishment of a 
home for the care and treatment of persons afflicted with leprosy, to be admin- 
istered by the United States Public Health Service; and either the Secretary 
of War, the Secretary of the Navy, the Secretary of the Interior, or the Secre- 
tary of Agriculture is authorized to transfer to the Secretary of the Treasury 
any abandoned military, naval, or other reservation suitable for the purpose, 
or as much thereof as may be necessary, with all buildings and improvements 
thereon, to be used for the purpose of said home or homes. 

Sec. 2. That there shall be received into said home, under regulations pre- 
pared by the Surgeon General of the Public Health Service, with the approval 
of the Secretary of the Treasury, any person afflicted with leprosy who pre- 
sents himself or herself for care, detention, and treatment, or who may be 
apprehended under authority of the United States quarantine acts, or any 'per- 
son afflicted with leprosy duly consigned to said home by the proper health 
authorities of any State, Territory, or the District of Columbia. The Surgeon 
General of the Public Health Service is authorized, upon request of said author- 
ities, to send for any person afflicted with leprosy within their respective juris- 
dictions, and to convey said person to such home for detention and treatment, 
and when the transportation of any such person is undertaken for the protec- 
tion of the public health, the expense of such removal shall be paid from funds 
set aside for the maintenance of said home or homes. 

11 



12 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Sec. 3. That regulations shall be prepared by the Surgeon General of the 
Public Health Service, with the approval of the Secretary of the Treasury, for 
the government and administration of said home and for the apprehension, 
detention, treatment, and release of all persons who ai % e inmates thereof. 

Sec, 4. That the Secretary of the Treasury be, and he is hereby, authorized 
to cause the erection upon such site of suitable and necessary buildings for the 
purposes of this act at a cost not to exceed the sum herein appropriated for 
such purposes. 

Sec 5. That when any commissioned or other officer of the Public Health 
Service is detailed for duty at the home herein provided for, he shall receive, in 
addition to the pay and allowances of his grade, one-quarter of the pay of said 
grade. 

Sec 6. That for the purpose of carrying out the provisions of this act there 
is hereby appropriated, from any money in the Treasury not otherwise appro- 
priated, the sum of .$250,000, or as much thereof as may be necessary, for the 
preparation of said home, including the erection of necessary buildings, the 
maintenance of the patients, pay and maintenance of necessary officers and 
employees, until June thirtieth, nineteen hundred and seventeen. 



TllKASCUY 1 >EPARTMENT, 

Office of the Secretaby, 

Washington, January 8, 1916. 
Hon. Joseph E. Raxsdell, 

Chairman Committee on Public Health and National Quarantine, 

United States Senate, Washington. 1). C. 

My Dear Sik : Referring to your communication of February 2, 1916. re- 
questing the views of this department on Senate bill 4086, providing for the 
establishment of a national leprosarium for the care of lepers, I have the honor 
to state that the bill has the hearty approval of the department, the necessity 
for legislation of this character having been apparent for many years. 

Put 2 or 3 of the 18 States in which leprosy prevails have been able to make 
proper provision for the care and segregation of those afflicted. Even where 
this has been done, the expense of providing custodians and nurses for indi- 
vidual cases has been considerable. Therefore, for economic reasons alone some 
measure should be devised for the custodial care of those who are ill of the 
disease. Considered from a humanitarian standpoint, there is all the more 
necessity for such a provision. The contagious and loathsome character of 
leprosy is such as to excite great abhorrence on the part of the general public, 
and wherever lepers are recognized as such they are immediately ostracised, 
and in certain instances have been driven from place to place. The Public 
Health Service is frequently called upon in instances of this character, where 
interstate migration has occurred, to provide care and treatment, and even in 
cases which do not come within the jurisdiction of that organization the Pub- 
lic Health Service is appealed to for assistance. For humanitarian and eco- 
nomic reasons alone, then, it is believed that the bill should receive indorsement. 

The establishment of a leprosarium in order to prevent the further dissemi- 
nation of leprosy in the United States is, without doubt, a measure of value. 
so that the contemplated enactment has a threefold purpose — economy, humani- 
tarianism, and the protection of the public health. 

In section 5 of the bill it is proposed that when officers of the Public Health 
Service are detailed for duty at the leprosarium mentioned they shall receive, 
in addition to the pay and allowances of their grade, one-half the pay of said 
grade and such allowances as may be provided by the Surgeon General, with 
the approval of the Secretary of the Treasury, Allowances of this character 
have already been sanctioned by Congress to officers of the Public Health 
Service detailed for duty at the leprosarium at Molokai, Hawaii, and it is 
believed to be no more than just, in view of the dangers and necessary isola- 
tion to which they are subjected, that the additional compensation should be 
allowed. 

Respectfully, 

W. G. McAdoo, Secretary. 

The Chairman. The committee will first hear from Dr. Dver. 




MAIN ADMINISTRATION BUILDING AND NURSES' HOME, LOUISIANA LEPER 
HOME, CARVILLE, LA. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 13 

STATEMENT OF DR. ISADOR DYER, DEAN OF TULANE SCHOOL OF 
MEDICINE. 

The Chairman. Will you please state your position in New Or- 
leans — your medical position? You are dean of the Tulane School 
of Medicine, are you not, Doctor? 

Dr. Dyer. Yes, sir. 

The Chairman. And have been for many years connected with 
work in regard to leprosy in New Orleans ? 

Dr. Dyer. Yes sir ; since 1894. 

The Chairman. Doctor, we would be very glad if you would tell 
us, in a general way and in your own manner, what you know about 
leprosy, its origin, and the remedies that may be applied to it, and 
in your opinion, what need there is for a national leprosarium, start- 
ing with the experience you have had with the disease. 

Dr. Dyer. I think the last part of the arguments, sir, would per- 
haps be briefer than the first. 

The Chairman. Just handle it in your own way, Doctor. 

Dr. Dyer. A discussion of the origin and treatment of leprosy 
covers a great many centuries, and while it would be interesting, I 
believe it would take up too much of your time to go into that. 

I believe we would be concerned most in the status of leprosy in 
the United States, as bearing upon the proposition to-day; and I 
would say, generally, that we have to look at it from two or three 
points of view. 

The first is that leprosy has been in the United States for over 200 
years, and probably at more than one point. 

The second is that leprosy has been introduced into the United 
States continuously since the first evidence we have, which was in 
the last part of the eighteenth century, and that during recent years 
more and more cases have come in, particularly since the close 
intercommunication with the Islands of the Caribbean and the 
Pacific Ocean. In other words, the new extraterritorial possessions 
of the United States have contributed considerably to the existence 
of leprosy in the United States. Lack of insistent isolation of lepers, 
as practiced in some other countries — I do not mean the absence of 
laws, but the lack of insistence upon local quarantine against 
leprosy — has resulted, in the United States, in a great many more 
foci of leprosy than there were a few years ago. 

The Chairman. Will you tell us how many of these foci there are 
in the United States? 

Dr. Dyer. I will get to that point rather deliberately, Mr. Chair- 
man, if you will allow me. 

The Chairman. Very well. 

Dr. Dyer. We know that in Louisiana and along the Gulf coast 
leprosy has existed since the latter part of the eighteenth century. 
The popular impression for many years was that leprosy in Louisi- 
ana came with the Acadians from Nova Scotia, and that impression 
was due, no doubt, to the fact that among the descendants of these 
people leprosy has existed, but the evidence seems to point to 'the 
fact that the disease came rather through the West Indies, par- 

33993°— S. Kept. 306, 64-1 2 



14 TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 

ticularly Martinique, where it has been known to exist, and Cuba, 
where we know it existed in Havana. 

In Florida, especially at Key West, the disease has existed for a 
number of years, and it has also existed in various coast towns in 
Mississippi, where leprosy is now found. 

A rather interesting experience has been in Texas, where the dis- 
ease has grown and extended from a small but steadily radiating 
center in Galveston to other cities. Leprosy in Texas is now found 
in Galveston, San Antonio, Eagle Pass, Laredo, Fort Worth, and 
probably in other places. The total number of known cases there is 
now, I think, 26. 

The Chairman. In the whole State of Texas? 

Dr. Dyer. In the whole State of Texas, yes. Leprosy has been 
cared for in California for many years. Their legislation on the 
subject goes back to 1890. 

Cases are reported from Oregon and from Minnesota, where the 
disease was introduced for the purpose of determining whether mi- 
gration would help its cure. 

Senator Works. Do you know how many cases are reported in 
California ? 

Dr. Dyer. The last report I saw stated there were 26 or more — less 
than 30 ; 26. 1 think. 

Senator Works. How many cases are there in the United States ? 

Dr. Dyer. That is a very hard question to answer. I can only 
answer that question by suggesting that the actual number of cases 
would have to be ascertained by multiplying by two or three times 
the number of known cases. 

Senator Works. Does our census enumerate the number of cases 
discovered ? 

Dr. Dyer. The last report was made by our Public Health Service 
and was necessarily inadequate, as it was based upon direct returns 
from State and local health authorities. 

Senator Works. How many were reported in that report? 

Dr. Dyer. I think the first report had 278, and the second report 
had about 170. 

Senator Works. Of that 170 or 278, as the case may be, whatever 
the number is, of cases in the United States, can you give any idea 
as to how many could have been excluded from the United States 
if the immigration laws had been strictly enforced? 

Dr. Dyer. I think comparatively few. 

Senator Works. You believe that the greater number of cases 
have been developed in this country itself? 

Dr. Dyer. I can answer the question almost categorically by saying 
that of the 278 reported the majority were reported from Louisiana, 
and of them there was only one foreigner. 

Senator Works. You believe that there is a majority of that num- 
ber reported from one State ( 

Dr. Dyer. Yes, sir; that is the reason why I say the report was 
inadequate. 

Senator Works. Do you think there are 278 cases in Louisiana ? 

Dr. Dyer. There are 105 in the leper home there now, and the 
actual number of cases ought to be determined by multiplying that 
number by 3. 

Senator Works. How is your institution maintained — by taxation? 



TEEATMENT OF PERSONS AFFLICTED WITH LEPROSY. 15 

Dr. Dyer. Our institution is maintained by the State, through 
taxation. I do not mean through any special tax fund, but through 
the general taxation. 

The Chairman. Have you any system of requiring the patients to 
pay? 

Dr. Dyer. No. 

The Chairman. You have a large charitable hospital in New 
Orleans where people do receive free treatment, have you not ? 

Dr. Dyer. Yes, sir. 

The Chairman. It might be that people could get in there and 
then be transferred to this leper institution, might it not ? 

Dr. Dyer. That really does not occur, because each case of sus- 
pected leprosy is thoroughly investigated. The procedure is that in 
case a leper is reported the case is turned over to my service for ex- 
amination. A report is then made to the board of health, which 
follows the law in segregating lepers. 

As illustrative of the inspection of a suspected leper, I would like 
to insert in the record an article by Dr. Ralph Hopkins and myself. 

(The article by Dr. Hopkins referred to is here printed in full, as 
follows:) 

The Diagnosis of Leprosy. 1 

By Isadoee Dyer, Ph. B., M. D., professor on diseases of the skin, medical department, 
Tulane University, of Louisiana ; consulting leprologist to the Louisiana Leper Home! 
etc., and Ralph Hopkins, M. D., lecturer on diseases of the skin, medical department 
Tulane University, of Louisiana ; visiting physician to the Louisiana Leper Home, New 
Orleans. 

Long association with the Louisiana Leper Home has given us an opportunity 
for the observation of leprosy, and we hope that this, together with the im- 
portance of correct and early diagnosis, in countries where leprosy is likely to 
occur, will justify the present discussion of this subject. We are not submitting 
any new points in diagnosis, but rather argue the need of a practical presenta- 
tion of the matter for the general profession, especially in our own country, 
where every now and then a notable case proves an ignorance of essential points 
which should be known. More than this, the reports of imported cases of 
leprosy in our seaport cities have shown conclusively either that the national 
quarantine against leprosy is a farce in its enforcement, or that the quarantine 
officials are ignorant of the symptoms of the disease. In New York chiefly 
numerous cases have been presented which have more or less recently been 
admitted to this country without hindrance. 

As a matter of fact, the increasing number of lepers in New York has grown 
by importation, as the disease so far is not held endemic there. 

The trouble in diagnosis lies more with atypical cases, with incipient tuber- 
cular cases, and with those anesthetic cases which present no longer active skin 
manifestations. Another source of confusion in diagnosis lies in the changes 
that appear in lesions during the periodic occurrence of exacerbations accom- 
panied by lepra fever. 

Like syphilis, leprosy has often been divided into stages and types, but, as in 
syphilis, the value of such diagrammatic classification of leprosy is greatly 
impaired by the fact that the types are often mixed and that the lesions that 
should be present in one stage are often found in another. Generally the type 
depends on the habitat of the bacillary cause, the anesthetic or trophic being 
due to nervous injury by the bacilli, the tubercular or nodular being due to the 
presence of the bacilli in the skin, and the mixed type being a combination of 
the anesthetic and tubercular forms. It is not unusual in the course of years to 
see a change in the type. The tubercular type in a mixed case may disappear, 
leaving only the anesthetic, and a purely anesthetic case may after years develop 
tubercles, forming the mixed type, which may in turn evolve a trophic type, 
having no tubercles in evidence. 

1 Read in the section on dermatology of the American Medical Association, at the sixty- 
first annual session, held at St. Louis, June, 1910. 



16 TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 

The usual sequence of the lesions after the prodromal period is that the first 
manifestation in almost every case is in macules, which usually initiate all 
types usually varying in their location accodingly. Much rarer is the bullous 
eruption which occurs in this same early stage. Tubercles usually appear later 
than macules and may be independent of them ; the ulceration and cicatrization 
of the skin occur ordinarily only in the terminal stage, though the perforating 
ulcer, which is a sinus leading to necrotic bone, may be found early, and in 
mutilating types the erosions following bullous leprosy may form true ulcers 
before any macules or tubercles present themselves. 

The macular eruptions do not always present the same characteristics. They 
vary from the size of a dollar, or smaller, to a patch large enough to cover an 
entire anatomic region ; the pigment may be almost uniformly distributed 
throughout the patch, as it is in chloasma, or it may disappear in the center, 
leaving a ring of pigment surrounding an area of skin lighter in color than the 
normal ; somewhat the same arrangement that ringworm of the general surface 
assumes, except that the atrophy of pigment in the center is marked and may, 
at the same time, involve the deeper skin. Scales are unusual in both types 
and occur usually only as a result of inflammation in the area or as the evidence 
of trophic disturbances. 

The first type, the uniformly pigmented macule, depends largely for its char- 
acteristics on the amount of infiltration provided by the presence of the bacilli. 
It may be simply a brown stain, level with the surface of the skin, with an irreg- 
ularly shaped border not always marginated, or a patch so elevated that the term 
macule becomes a misnomer. On the other hand, there may be multitudinous 
macules, with symmetrically bilateral distribution on the trunk and extremities 
alike, entirely free of bacilli and having all the characteristics of a true 
erythema. 

This form of macule is particularly common in anesthetic leprosy in which the 
early involvement of the nerve trunks of the extremities points to the toxic 
influence of the leprous deposits along the nerves. This is particularly argued 
in the facts that such eruptions of macules are evanescent and that the lesions 
themselves are highly colored, bright red, and are often apt to be hyperesthetic 
and not anesthetic as are the more deeply pigmented and infiltrated lesions. 

In the second form the margin is well defined, and the brown color becomes a 
purplish red. Between these two extremes are the variations in shade made 
possible by the varying degrees of inflammatory infiltration. The favorite 
location is the buttocks, though the face, trunk, and limbs may also be involved, 
and these macules are often the sites of later tubercles or nodules, especially 
when found on the face. Though these may not be necessarily symmetrica! 
when they first appear, later these macules become so as the eruption fully de- 
velops. During the periods of lepra fever the macules may become intensely 
inflamed and painful, and though the fever does not usually occur severely dur- 
ing the incipient period, we have had at the Louisiana Leper Home instances in 
which the whole macular areas, numbering four or five as large as the palm of 
a child's hand, have ulcerated. Ulceration in the incipient stage is indeed rare 
and can be explained only by the lepra fever, which is evidently a manifestation 
in greater or less degree of fulmination of deposits of lepra organism, or else 
the acute reaction associated with new fields of invasion. 

In the circinate type the patch of lepra macules usually grows in size after it 
first appears, spreading from the outer border of the ring, which preserves a 
well-defined margin ; and it is more often associated with the anesthetic than the 
tubercular form. The inner margin of the ring is not liable to show as well- 
defined a border as the outer, and as the lesion grows larger in area the paler 
center grows also, keeping the pigmented ring nearly constant in relative 
breadth. The degree of infiltration in this type of macule is not as variable as 
in the first type, usually remaining slight, and the color varies with the depth 
of infiltration. This, too, is found almost always as a light brown, aptly de- 
scribed as a caf§ au lait, which is the characteristic color of all of the macules 
that present the least amount of infiltration. A reddish tinge is added to the 
brown of the border in those cases with more marked infiltration, the resultant 
color being a red-brown, which is again intensified during the lepra fever. This 
circinate type may occur on any part of the body, but the hands and head are 
not as liable to this as to the form in which the macule presents a uniformly 
pigmented area, appearing en plaque. The areas of especial predilection are the 
shoulders, legs, thighs, buttocks, and forearms, in the order named. It is not 
infrequent to find confluent lesions of this type forming grotesque ribbons of 



TREATMENT OF PEESONS AFFLICTED WITH LEPEOSY. 17 

irregular borders and outlines extending along the whole of an extremity or 
showing symmetric figures over the back. 

The bullous eruption, which is very rarely seen, occurs associated with this 
early stage, or precedes the macule if it occurs at all. The bulla? contain serum 
at first, but become pustular in a short time. They are not larger than a small 
marble, and occur most frequently on the hands and feet. The clinical diag- 
nosis is frequently difficult without other evidences of the disease. The bullae 
have a predilection for the areas over the knuckles of the fingers and will repeat- 
edly appear in the same site, establishing scar areas with encircling pigment, 
which is characteristic. Often these lesions lead to ulceration and even trophic 
changes in many cases misleading to a diagnosis of neuritis and not infrequently 
escaping the suspicion of leprosy for months or years, in the hands of neurolo- 
gists. Several cases have finally come to a diagnosis of leprosy when the skin 
evidences of macules or tubercles elsewhere have developed. 

On the feet the bullae seldom appear so early, and when they do come they are 
found on the plantar surface, usually going on to actual ulceration, trophic in 
character. 

Late leprosy will develop bullae as evidences of trophic changes, and here the 
destruction of skin and deeper tissues is the rule, finally causing the destructive, 
amputative deformities found in nerve leprosy and the loss of terminal or inter- 
mediate phalanges of the digits of fingers and toes. 

The tubercles in leprosy have their favorite location on the face, involving 
especially the lower part of the forehead, the ears, the nose, the chin, the 
cheeks in the order named. The hands and other parts are less frequently 
involved. 

They may begin in the patches of a macular eruption or they may develop in 
normal skin. When sufficiently developed tubercular or nodular leprosy is 
essentially a bilateral, symmetrical disease. In some cases individual tubercles 
can not be distinguished, but the whole skin of the face is greatly infiltrated, 
thickened, and discolored, the surface remaining smooth or more often cut by 
furrows sometimes a quarter of an inch deep in the natural lines of cleavage 
or in the folds of the forehead, cheeks, or chin. This furrowed type is espe- 
cially marked on the cheeks and forehead and gives the leonine expression to 
the countenance more strikingly than the other varieties. In other cases the 
tubercles preserve their integrity, studding the face in their favorite areas of 
distribution with nodules varying in size from a pea to a marble. The color is 
usually a dusky reddish-brown or may be waxy white in those cases in which 
the lesions are scattered and which are usually the most malignant. Each 
individual nodule is rounded at the base and spherical in contour, much as if 
peas or marbles had been stuck in the skin. 

The eyebrows and beard may fall in this type, but as the scalp is not usually 
affected its hair may be preserved in its integrity until very late in the disease 
or to its termination. 

Periodically in the course of the disease there may occur an outbreak of 
tubercles, evanescent in character, highly inflammatory, and very painful. 
These occur during the course of the lepra fever before mentioned, which may 
last from one to five or six weeks, or even longer. These tubercles are deep- 
seated and dull red in color, not showing the brown pigment of the chronic type. 
They fade away with the subsidence of the fever and sometimes one crop will 
disappear to be replaced by another before the temperature returns to normal. 
The inflammation in this type is sometimes so intense that vesicles and bullae 
develop on the tops of the tubercles, and some may even undergo suppuration 
• with the formation of abscesses. Their distribution over the body is far more 
general than that of the permanent tubercles, as they occur not only on the face 
and hands but also on the trunk and on both the flexor and extensor surfaces 
of the extremities. The type of fever referred to as lepra fever is not the 
fever usually described as one of the prodromal symptoms of leprosy, but is an 
irregular elevation of temperature ranging from 100° to 104° F. and asso- 
ciated either with marked changes in the macules or tubercles present before 
the occurrence of the fever or with the formation of such tubercles as have 
just been described. These tubercles may be especially recognized by their 
tendency to uniformity in size and their usual lenticular shape as if a flat bean 
were embedded in the skin. 

The lepra fever has two distinguishing symptoms, the rise in temperature 
and the development of tubercles different in many characteristics from the 
lesions found as the usual evidences of leprosy. In the tubercular and mixed 
cases it occurs at varying intervals of time and is of varying duration, while 



18 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

in the pure anesthetic and trophic cases, as there are no tubercles, the skin 
evidences are lacking. Though there may be periodic rises of temperature, 
they are often associated with the suppuration which is the result of nerve dis- 
turbances and which is more liable to affect the bones and joints than the 
skin. In consequence the cardinal point in the diagnosis of lepra fever is 
lacking. 

The inflammatory evidences in the tubercles accompanied by a general rise 
of temperature occur in almost every case of tubercular or mixed leprosy, 
though the symptoms are sometimes of so slight a character as almost to 
escape observation. The temperature may vary from so slight a rise above 
the normal as to occasion merely a feeling of malaise to a grave febrile con- 
dition. The range of temperature is from 99° to 105° or 106°, and two cases 
have been observed in which the result was fatal. The attack is often ushered 
in with a chill and the duration is very variable — from a few days to several 
weeks or even months. Some patients have been known to have as many as 
three or four attacks during one year. The chief features of the temperature 
chart are the remittent character of the fever and the sudden great rises and 
fall of temperature. The chart of a well-marked case very closely resembles 
that of septicemia. 

The occurrence of marked inflammatory symptoms in old tubercles, infiltrated 
patches, macules, or in areas of skin which apparently were previously healthy, 
is coincident with the rise of temperature and is characterized by swelling, red- 
ness, pain, and, rarely, suppuration. The occurrence is most frequent in old 
tubercles and least frequent in areas of skin which previously were not involved. 
The duration of the inflammatory nodules is short, but one crop is followed by 
another as long as the fever lasts. The location is most frequently on those 
parts of the body that are involved by the chronic characteristic nodules of 
leprosy, the face, neck, hands, and also the arms and legs. The distribution 
seems, like that of the chronic lesions, to prefer those parts of the body in which 
the temperature is lowest. The trunk is less frequently involved, and we have 
seen no cases involving the scalp. The number of lesions found at one time is 
very variable and they are disseminated with an irregular, bilateral symmetry. 
They vary from the size of a split pea to that of a hen's egg. The elevation 
above the surrounding skin is well marked and the nodules are of a globular 
contour, usually rounded in outline and distinctly limited in area. The color 
is uniformly red — a brighter and more brilliant hue than the dusky purplish 
red of the stationary tubercles, from which they can be differentiated not only 
by their inflammatory character but also by their rapid development, their 
evanescent character and an occasional tendency to suppurate and occur on parts 
of the body not usually affected by permanent bacillary deposits. Unless sup- 
puration occurs the nodules are quite firm to touch and most resemble those 
found in erythema nodosum. It has been a matter of observation that often 
after attacks of lepra fever there has been improvement in the old tubercle 
and in the general condition, which seems to argue that during these attacks 
some bacillary product is formed which not only causes the elevation of tem- 
perature but also either directly affects the life or growth of the organisms, 
or indirectly, through the elevation of temperature, produces a condition un- 
favorable to the germ life. 

In support of the latter view may be mentioned an observation made by Dr. 
F. B. Gurd, of the department of pathology of Tulane, in which the pus from 
an abscess caused by the suppuration of an inflamed tubercle was found to 
contain no organism except the bacillus of Hansen. These bacilli were found 
to be incapable of cultivation under the same conditions in which other Hansen 
bacilli had been found to flourish. 

It is also interesting to note that during the administration of a series of 
hot baths, in which an effort was made to maintain an elevation of temperature 
of 104° for several hours, two tubercular cases developed lepra fever. If we may 
be permitted a little speculation, the great improvement derived from elevation 
of temperature, even in advanced cases of leprosy, may be explained on the 
hypothesis that the lepra bacillus does not thrive at high temperatures. The 
location of the chronic tubercles is very suggestive of this, as is also the im- 
provement noted after erysipelas, lepra fever, and artificial elevation of tem- 
perature by means of hot baths. It seems possible that the products of the 
disintegration of dead bacilli provoke a general rise of temperature as well as 
the local heat of inflammation, and that the febrile condition thus produced re- 
acts on bacilli in other locations, which, in turn, in their disintegration, liberate 
fever-producing toxins. It is conceivable that such a process should continue 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 19 

until all the less viable bacilli become destroyed, when the temperature returns 
to normal and old lesions show considerable improvement. 

With the exception of the tubercle associated Avith the lepra fever the nodules 
of leprosy seem to have a marked preference for the exposed parts of the head. 
The scalp is almost always free, while the ears are, on the contrary, almost 
always involved. They become enormously enlarged either by the presence of 
tubercles, in the lobes especially, or by a diffuse infiltration, both of which 
cause a marked discoloration. It is not unusual to find, even in terminal cases, 
tubercles present massed over the entire face and ulcerating, the limit of the 
most aggravated part of the eruption clearly marked by a line around the neck 
about where the shirt-band rests. On the trunk and arms and legs the macular 
eruption is far more common than the tubercular, though nodules may oc- 
casionally be found over a macular patch or even on a part of the skin present- 
ing no other lesions. The tubercles never mass over the entire body as they do 
over the face. The most common condition on the hands is the thickening of 
the skin and pigmentation, with tubercles more sparsely scattered than on the 
face, the color being a dusky brown. The infiltration and swelling of the hands 
so affect the skin as often to cause a papery consistency like thin parchment. 

The ulcers of leprosy are of two kinds, the perforating and the purely cutane- 
ous. The latter occur most frequently on the face and on the legs. On the face 
they are usually superficial, but those around the mouth are liable to cause con- 
siderable destruction ; and when the ulceration has healed the shrinking result- 
ing from cicatrization will reduce the mouth to about one-third its normal size. 
The ulceration of the face occurs only in the terminal stage, when the tubercles 
have become large and thickly aggregated, and it is found only in the tubercular 
and mixed types, the trophic form, or nerve leprosy, showing in the face only 
by the infiltration of the whole mask of the face, with thinning of the epidermis, 
leaving the skin glossy and pigmented. The ears in this form are often flabby 
and pendulous ; ectropion causes a stare, which is a peculiarity of this disease. 
The cause of the breaking down of the nodular masses seems to be due more 
to a disturbance of circulation in the skin than to the bacilli present, and this 
seems true also of the ulcers of the leg, where the circulatory balance is easily 
disturbed by gravity. 

The perforating ulcer is associated only with the anesthetic form and is found 
only on the -hands and feet, and more often on the ball of the foot than else- 
where. It is a surgical condition, being a sinus leading to necrotic bone. The 
horny layer of the skin is much hypertrophied when the ulcer is on the foot, 
and the condition is painless. 

A strong confirmatory symptom of leprosy is the anesthesia found in all types. 
In the tubercular type it is confined to the lesions, but in the anesthetic it 
spreads over the area of distribution of the nerve affected. The sense of pain and 
temperature are lost before the sense of touch, and in the anesthetic type the 
nerves most frequently involved first are the ulnars. The loss of sensibility be- 
gins usually in the tip of the little finger and spreads gradually to the adjacent 
fingers and up to the forearm. Other nerves become involved later on and the 
anesthesia may become general. In this instance there is always either marked 
thickening of the ulnar nerve or distinct nodes along the nerve. The left side 
is more often the first to be affected. 

The mutilation in the anesthetic or nerve type is almost confined to the hands 
and feet, usually being limited to a loss of the fingers and toes, and is due 
to trophic changes caused by nerve destruction. The atrophy may be manifested 
by the " claw hand," in which the flexor tendons and muscles shrink more than 
the extensor, drawing the fingers up and preventing extension, or it may affect 
the bones, causing either necrosis or a gradual degeneration and absorption. 

When necrosis occurs a perforating ulcer is established and persists until 
the fragment of dead bone, sometimes an entire pttaianx, is discharged. The 
ulcer then heals, leaving the finger or toe shortened by the loss of bone. When 
necrosis with suppuration does not cause the loss of bone in mass a slower 
process of absorption goes on, and the flexed fingers become shrunken masses of 
flesh with atrophied nails at their extremities. 

The curious condition of an amputation at the joints by constricting circular 
atrophy, just as in the disease known as " ainhum," is often observed, and fingers 
and toes are often lost in this painless way. A band of fibrous tissue forms 
around some part of the digit and gradually constricts the underlying tissues. 
The band is usually about one-quarter to one-half inch in breadth, and as it 
grows tighter the tendons and bones under it atrophy until the finger is left 
hanging by a fibrous band, which can easily be cut off with a pair of scissors ; 



20 TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 

or if left to itself, the finger will fall away, the patient often being unconscious 
when the loss occurs. 

The suppuration attending the necrosis of bone may extend to joints involving 
the articulations at the wrists and ankles and occasioning a condition like tuber- 
culous or septic arthritis. 

Considerable attention has been directed to leprosy in the United States, and 
recent cases have enforced the belief that not enough emphasis has been placed 
on the training of Government physicians with regard to this disease. The 
notoriety attaching to the Early case alone, which excited the qualified criticism 
of at least two distinguished foreign leprologists, may be cited in point. 

The United States has specific immigration laws which require the deportation 
of lepers ; yet in 1908 several patients with advanced leprosy were shown in New 
York at the international dermatological congress, and some of these cases 
were in recently imported foreigners. 

Within the past three years Dr. Dyer has seen two lepers from Central and 
South America who reached New Orleans by way of New York. These cases 
were well enough marked to have been recognized by any health officer who had 
even a meager idea of the disease. 

It is highly important that the cardinal symptoms of leprosy should be learned 
by the officers of the public health, so that importation of leprosy may stop. It 
does not require any more legislation, but more education of port physicians. 

The salient points of diagnosis in leprosy consist in the recognition of the stamp 
of the disease, which is always suggested by the dusky hue, the swollen skin, the 
overhanging eyebrows, and the raucous voice. The hands, too, have a thinned 
epidermis and an altered color which is different from that in any other disease. 
The presence of tubercles in the skin of the face, at the lips and about the 
nose, with others in the pendulous parts of the ears — all these should make a 
case suspicious. 

The differential diagnosis of leprosy clinically is at all times simple. There 
are only two conditions which at all resemble tubercular leprosy, iodism and 
disseminated tuberculosis cutis. The first-named condition is seldom seen in 
the areas common to leprosy and the nodules of iodism are highly inflammatory 
and ready to break down. 

With tuberculosis of the skin the lesions are numerous, small, and deep- 
seated, under the epidermis as a rule. They are dirty white in color and seldom 
assume a reddened hue. Moreover, this condition on the face is unusual, and 
when it does occur the lesions are more apt to occur bilaterally and symmet- 
rically in numbers on the cheeks and wings of the nose than elsewhere. 

We would finally make the point that all physicians should report any cases 
of leprosy coming under their observation, so that the actual occurrence of this 
disease in the United States may be studied and the statistics derived may be 
of some value in establishing an institution for the care of leprosy under 
Government control and expense. 

Senator Works. How many of the people afflicted with leprosy in 
Louisiana are foreign born ? 

Dr. Dyer. Comparatively few. Nearly all are native born. Those 
given as foreign born in the statistics from which we have drawn 
have lived in Louisiana from 10 to 30 years. 

Senator Works. Where do you think that disease came from ? 

Dr. Dyer. It was contracted in the State, so far as the most of us 
believe; it has never been proven to be hereditary, and the evidence 
points to direct contagion. The disease is apparently contracted as 
tuberculosis is. 

Senator Works. You think it is a contagious disease? 

Dr. Dyer. Yes, sir ; I do. 

Senator Smoot. It has been a long time ago, but I have slept in 
houses where there were lepers. It is true, I had my own towel and 
my own calabashes and slept in my own sleeping bag. I have slept 
in houses where there were lepers who had their faces all drawn out 
of shape and their arms twisted out of shape in all conceivable ways. 
1 have been on the leper island time and time again. I have visited 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 21 

there and seen just how they live. I knew the doctor in charge of 
them. I am speaking now of Molokai, Hawaiian Islands. 

Dr. Dyer. Yes. 

Senator Smoot. If that disease is contagious, I think I ought to 
have it. 

Senator Works. Are you able to trace this disease back to incoming 
immigrants ? 

Dr. Dyer. In Louisiana we of course have not, because the early 
history of the disease is probably too far back for us to derive facts 
on this point. What we have been able to do has been to study a 
group of cases coming from one or another section of Louisiana. 
We have undertaken in Louisiana to find the foci of the disease. 
There are at least two in New Orleans and three in the State. The 
chronological history of leprosy in Louisiana has shown that the 
disease has gradually spread until there are 32 out of 59 parishes in 
the State involved. The whole history of the Galveston cases may' 
be traced to St. James Parish in Louisiana. That would show that 
the disease is contagious. 

Senator Smoot. How do you account for cases such as mine, for 
instance, where no results have appeared as the result of sleeping 
in the same house with lepers ? 

Dr. Dyer. I think the probable explanation of that would be that 
people have escaped infection from lepers just the same as they have 
lived in the same house with people who have tuberculous and did not 
contract that disease; but they are certainly taking chances, as you 
probably did yourself. Leprosy is very much less contagious than 
most diseases. 

Senator Smoot. My case is similar to thousands of others. 

Dr. Dyer. That is the experience of attendants at the leper home. 
It is probably because they are careful. It does not prove that the 
disease is not contagious. The disease is certainly contagious, and 
these cases where people do not take it from lepers are susceptible 
of no other explanation, it seems to me, than the one I have given. 

Senator Smoot. I do not want you to think that I did not believe 
that it could be transmitted. 

Dr. Dyer. No. 

Senator Smoot. I think, however, that the only way it can be trans- 
mitted is to come into contact with a towel, for instance, which has 
been used by a leper, or drinking out of a vessel or cup that has been 
used by a leper, or coming in contact with any kind of clothing worn 
by lepers, which has come in close contact with the person's body. 

Dr. Dyer. We have had two clear cases where the disease has been 
contracted by living in a house which had been vacated several years 
before and occupied again without disinfection. In Louisiana we 
also have a case where a child has contracted the disease and after 
several years the father and mother developed it. 

Opinion is divided as to the contagiousness of leprosy, but I think 
that men who have lived among colonies of lepers are all of the 
opinion that the disease is contagious; and the experimentation that 
has been made with the lower animals rather points to that fact. The 
disease has been produced by inoculation in monkeys and white rats, 
and even in cold-blooded animals, such as fish, and the disease has 



22 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

grown. Experimentation with human subjects lias been entirely too 
ancient and too uncertain to place any reliance upon as proof. 

Senator Works. Just what provision has been made for caring for 
these afflicted people in your State? 

Dr. Dyer. The State enacted a law in 1894 providing for a board 
of control which was authorized to create and take care of a home 
for lepers, and an initial sum of $10,000 a year was appropriated to 
take care of this institution. A ground lease was taken on property 
about 60 miles above New Orleans, on the Mississippi River, and at 
first the old cabins on the plantation were used for the lepers, of 
whom originally there were 10 transferred from the pesthouse in 
New Orleans. The accommodations have gradually improved until 
now the old cabins have all been destroyed and the institution is on 
the pavilion system. The males and females have been segregated 
in different parts of the camp, the more advanced being separated 
'from those of milder types. The houses are all modern cottages; 
each cottage will care for anywhere from 6 to 20 patients, with 
usually not more than 2 patients to a room. The cottages are pro- 
vided with all modern conveniences for bathing — hot and cold water — 
and all sanitary arrangements. The houses are all thoroughly 
screened. There is a central dining room, and the colony has also 
a chapel for services and a place for exercise. When the home 
was started it was rather difficult to get proper nursing; so the 
Sisters of Charity of the order of St. Vincent de Paul were asked 
to take charge, and they have done very efficient work. 

Senator Works. What has been your experience in your effort to 
induce people to take treatment there and live there ? 

Dr. Dyer. I shall have to make a division of your question in order 
to answer it properly. 

The home has been exceedingly satisfactory from the standpoint 
of voluntary admissions. I should say that 80 per cent of the pa- 
tients who have gone to the Louisiana home have gone voluntarily. 
At first it had the fearfulness of any such a place and it was looked 
upon as an asylum, and not a hospital; but gradually that prejudice 
has been overcome. 

The law provides for leprosy as it does for any other contagious 
disease. The disease must be reported just the same as any other 
contagious disease ; there is a penalty for harboring a leper, and they 
get no treatment outside, if it is known to the authorities. When 
the purposes and conveniences of the home are described to them, 
and contrasted with their surroundings at home, where they are nec- 
essarily concealed, the cleanliness and comforts of the leper home 
contrasted with the dirt generally and the inconveniences of their 
poor surroundings, there is little difficulty in persuading them to go 
to the home. We explain to them that there is a certain degree of 
freedom at this home, and we do not keep them in confinement. 
No asylum should be conducted on those lines. We have practically 
abandoned the idea of compulsory isolation. Sometimes they have 
refused to go, but those cases would not amount to probably more 
than 20 per cent of the admissions. 

Senator Works. Do patients who are able to pay bear part of the 
expense ? 

Dr. Dyer. No, sir ; they are not taxed at all. 

Senator Works. How far is the colony from a city? 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 23 

Dr. Dyer. It is about 30 miles from Baton Rouge. 

Senator Works. That is the closest city ? 

Dr. Dyer. There is a small town on the other side of the river — 
Whitecastle, La., which has about 2,500 people — and then there is 
another small settlement which is about 3^ miles from it. 

Senator Smoot. Do you think that mosquitoes and flies can convey 
the disease? 

Dr. Dyer. That is another question. In the Sandwich Islands they 
have found the bacilli of leprosy in the mosquito, and some experi- 
mental work has been done in the University of Pennsylvania with 
the bedbug, where the bacilli of leprosy have been cultivated through 
the bedbug. However, any opinion as to that would have to be a 
hypothesis. It is very hard to argue that. We do not know the 
source of contagion. The general opinion seems to be that it spreads 
very much as tuberculosis does — through inhalation through the nose 
and mouth. 

Senator Smoot. Perhaps the only danger in being in the midst of 
lepers is in contracting the disease through transmission by bedbugs 
and mosquitoes. 

Dr. Dyer. The bedbug is practically the only insect that would be 
likely to carry it, as that is the only insect that can live in an aban- 
doned house very long. It might be carried for three or four years 
that way. 

Senator Works. Do you think your State is prepared for taking- 
care of these lepers adequately or reasonably ? 

Dr. Dyer. I think it is reasonably prepared ; yes. 

Senator Works. Why would it not be possible to care for patients 
there from other States? 

Dr. Dyer. The object of the home was to get rid of leprosy in 
Louisiana, and, with that end in view, it. would not be a good policy 
to receive patients from other States. 

Senator Works. But the object has not been attained, has it? 

Dr. Dyer. No ; but that is probably due to the fact that investiga- 
tion of leprosy within the State of Louisiana has not been sufficiently 
exhaustive to bring all the patients into that home. 

Senator Works. How many leprosy patients do you think you 
have in Louisiana, outside of your institution ? 

Dr. Dyer. I think the number is probably three times the number 
of inmates. 

Senator Works. That is, the total number in Louisiana would be 
three times the number you have in the institution ? 

Dr. Dyer. Yes. 

Senator Works. I meant including them all — that is, outside of 
the institution. 

Dr. Dyer. If we deduct 105 from three times that number, you 
would have 210. I would say there are probably 300 lepers in 
Louisiana. 

Senator Works. There is this question involved in it, how far the 
United States Government should go in dealing with a question of 
that kind. From California there is a bill introduced here asking 
the Government to appropriate money to take care of tubercular 
patients, of whom a great number are brought there by the favorable 
climate and other conditions which people seem to consider will en- 
able them to recover more quickly. Of course, if we start in that 



24 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

direction, it is hard to tell where we will stop. I do not sympathize 
at all with the tuberculosis bill, although it is intended to benefit my 
own State. I think California can take care of her tubercular pa- 
tients, and I think it should do so. That may be so in regard to 
leprosy, too. I think that is an important question. 

Dr. Dyer. I should like to meet that. 

Senator Works. I should like to have you meet it. 

The Chairman. We would be very glad to have you say something 
on that, Doctor. 

. Dr. Dyer. I have not tried to argue that Louisiana had a majority 
of the lepers in the United States. I want to remove that im- 
pression. 

Senator Works. I am not speaking particularly of Louisiana, or 
particularly of any other State. I am talking about all the States. 

Dr. Dyer. I understand. The reason why Louisiana has appar- 
ently more lepers than any other State in the Union is because Louisi- 
ana has tried to take care of its lepers, and has induced a count of 
the lepers of the State, which has not been done elsewhere, except in 
Massachusetts and California. Massachusetts started with two or 
three patients, and now has nearly 20 in its institution on Penikese 
Island. In New York City, at a demonstration in 1912, there were 
introduced 17 or 18 cases, simply to exhibit the kinds of lepers they 
had. A short while ago it was estimated that there were 100 lepers 
in New York City. Cases have been reported rather conspicuouslv 
from other places, like Cincinnati and Chicago, and occasionally a 
case from St. Louis. A true count has not been made of the number 
of cases. The count of the Public Health Service is adequate, be- 
cause it could not be based upon a thorough investigation. They 
wrote to the local health authorities who were supposed to know of 
cases in their localities, and the report was based on the answers 
received to their inquiries. There could be no exhaustive search 
made for cases. It is known that cases to a considerable number exist 
in Florida, Mississippi, Louisiana, and Texas. In some of those 
States the disease is known to be prevalent. 

In a report drawn up 12 years ago, following the report of the 
Public Health Service by two years, the total number of cases I 
found was over 400. I simply used reports which had been made 
in the medical journals to arrive at my statistics, together with those 
cases Avhich were reported from institutions which cared for lepers 
in this country. 

I think the argument for a national leprosarium is probably 
greater than for an institution for tuberculosis. I would put it 
this way: The patients with tuberculosis have a large sympathy 
from the general public. The patient with tuberculosis travels on 
the public carriers; he goes to different resorts and places where he 
may be cared for in sanatoria; while, on the other hand, there are 
very few States that do not discriminate against the leper. If it 
were known that a leper was on a train the chances are he would 
have the train to himself because of the public horror of the disease. 
This reflects upon the leper himself in so much that it places him in 
the attitude, the mental attitude, of the criminal. He is dis- 
criminated against in all public places, to the end that he becomes 
an outcast and an object of horror in spite of the fact that the 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 25 

clanger of contagion from him is about 1 to 100 as compared with 
the tubercular patient. I think that anyone who has lived in a 
community with lepers, who has had much contact with the leper 
himself, and has studied the psychology of the leper, must realize 
that he is entitled to large consideration. He not only bears all the 
burdens of his disease, but he also bears the burdens of centuries of 
opprobrium which makes him psychopathically different from a 
patient suffering from any other disease. For that reason they 
need just that much more care. I have seen a young girl, in ex- 
cellent circumstances, starting out as a beautiful specimen of girl- 
hood and growing, in three or four years, into a horrible and loath- 
some object. There is no other disease that imposes such a burden 
upon the patient as does leprosy. 

Senator Works. The question is, Who should render the service; 
the States or the Government? As far as traveling on the same car 
is concerned, and the consequent transportation of the disease from 
one State into another, that comes under the National Government, 
undoubtedly; but isn't it the duty of the State to bear the burden 
of taking care of their own native-born citizens, like they are doing 
in Louisiana and in California and in Massachusetts? Now, I un- 
derstand that there the question is not Federal. I think adequate 
provision ought to be made for these people. There is no doubt 
about that. It is strictly a humanitarian question. But there is 
serious question as to how far the National Government ought to go 
in matters of this kind. 

Dr. Dyer. The argument I think can be met at once. We have 
isolated cases. That happens all the time. For example, in the 
State of Pennsylvania there may be five lepers; there may be five 
in the State of Arkansas; and there may be a few States in the 
Union where there are no lepers at all, but where there might be 
one found in the future. It would seem to me that there should be 
some sort of concerted action by those States to take care of the 
lepers in their communities. As soon as the interest extends into 
a number of States it becomes the interest of the National Govern- 
ment. Louisiana is not asking here for her lepers to be taken care 
of; I am not here for Louisiana, but I am here at the invitation of 
your chairman, to present this matter to your committee. Louisiana 
has been willing to take care of her own lepers, but I do not think 
it is willing to take care of those from other States. If the National 
Government took over this function, Louisiana would be glad to get 
rid of her burden of taking care of these people, and to get rid of the 
tax which it lays upon the people. I think that would be true in 
every other State. 

The Chairman. What is the average annual cost of maintaining 
this institution in Louisiana? 

Dr. Dyer. The appropriation is about $20,000 a year. 

Senator Smoot. That is about $200 a patient ? 

Dr. Dyer. About $200 a patient; yes. 

The Chairman. What is the value of the institution ? 

Dr. Dyer. I should say about $30,000. The buildings erected' are 
mostly frame structures. 

The Chairman. In connection with Dr. Dyer's testimony, I wish to 
say, in introducing this bill, I had not heard from a single man in 



26 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Louisiana on the subject. No one there had called it to my attention. 
I was aware, of course, that my State had had a leper's home and 
was taking care of its lepers in what I conceived to be a magnificent 
manner. This matter was first brought to my attention by Mr. 
Danner, who is American secretary of the mission to lepers. We 
talked it over, and he told me of the number of lepers in the United 
States, of the horrible condition of many of them, some of them 
being in solitary confinement and suffering like criminals, and his 
story impressed me with the necessity for something being done, and 
I introduced this bill at his suggestion. The bill did not come from 
Louisiana at all. The situation was laid before me, and seemed to 
me to be a matter that ought to be taken up, particularly in view of 
the fact that none of the States with the exception of Massachusetts 
and California and my own State of Louisiana had taken steps 
along this line. I simply make this explanation to show you that the 
bill was not introduced for the State of Louisiana. 

Senator Weeks. Of course not. 

Senator Works. I was not intimating that Louisiana alone was 
interested in this question. I was rather putting it on the broader 
ground that any State alone was interested in it or should be in- 
terested enough to take care of her own citizens and that the burden 
ought not to be shifted to the Federal Government. I did not have 
any particular reference to Louisiana. 

Dr. Dyer. I think I understood you. In connection with the last 
phase of what I had to say it probably appears that Louisiana has a 
majority of the lepers of the United States. Louisiana really has a 
minority of the lepers and not a majority. 

Senator Smoot. We all agree that lepers should be isolated. I 
think there is no division of opinion on that. We all believe that 
smallpox cases should be isolated, and we all believe that each State 
should take care of its smallpox cases within the State. A differen- 
tiation can be made between smallpox cases and leprosy cases to this 
extent, that smallpox can be cured or stamped out in a short time. 
It is only a short time after it breaks out until the patient is either 
dead or well. Now, in the case of the leper, once a leper he is a leper 
forever. 

Dr. Dyer. Unless he is cured. 

Senator Smoot. I have never heard of any cures. There may be 
some. 

Dr. Dyer. That is important, as the last phase of the argument. 

Senator Smoot. I do not know of any. I would be very much 
pleased to learn that there was a cure for leprosy. 

Dr. Dyer. Oh, yes. 

Senator Smoot. Have you ever cured any in Louisiana? 

Dr. Dyer. Yes, sir. 

Senator Smoot. How many? 

Dr. Dyer. About 30 cases in the last 20 years. 

Senator Smoot. Do you know whether any of those cases to-day 
are alive? 

Dr. Dyer. Several of them; three or four of them I have seen 
walking in the streets of New Orleans lately. 

Senator Smoot. How long have they been well? 

Dr. Dyer. Some of them have been well for 19 years. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY, 27 

Senator Smoot. You have studied the details of it from a medical 
standpoint, which, of course, I have not ; and you have followed the 
individual cases, where I have not. I have only followed leprosy as 
a whole, as I have seen it. 

Dr. Dyer. Yes. 

Senator Smoot. You, of course, have studied it from a medical 
standpoint ? 

Dr. Dyer. Yes. 

Senator Smoot. Do you know what percentage of cases on the 
Hawaiian Islands, for instance, have been cured? 

Dr. Dyer. No ; I do not. 

Senator Smoot. Do you know of any cases that have been cured 
at Molokai, say? 

Dr. Dyer. I do not know. I am not familiar with the course of 
treatment there. There has been issued within the last two years? 
from the Public Health Service, a report of the work done in the 
Philippines by Dr. Heiser, which shows a number of cures. 

Senator Smoot. I can not say as to the qualifications of care and 
attendance, from the standpoint of a physician, but I do know that 
on the island of Molokai, in the Hawaiian Islands, every care is 
given a patient, and I have understood the patients have the very 
best medical treatment. 

Dr. Dyer. I will tell you of the experience Dr. Heiser had in 
Louisiana. Dr. Heiser, an officer of the Public Health Service, was 
director of health in the Philippines. While on furlough in the 
United States he wanted to visit the Louisiana home and see how it 
was conducted, with an idea of getting some suggestions for his work 
in the Philippines. He came and after a thorough examination of 
the patients there he was very much struck with the ameliorated con- 
dition of many of the inmates, and he asked with regard to the treat- 
ment, which was not new at all. It had been used for a couple of 
hundred of years in India. 

He asked, " How long does it take you to get results ? " and I said, 
" The patient seems to get better in six to eight months, but we have 
never cured a case in less than three years." He seemed very much 
astonished, and said that he had expected to get results in three or 
four months. Now, gentlemen, that is the impression most people 
have. I know of cases in Louisiana where a patient did not show 
any sign of improvement until after three years, and it was five years 
before the patient was free from the disease. 

Senator Smoot. Do you think the leper should be in a warm 
climate or in a moderately cold climate? 

Dr. Dyer. The disease seems to spread more and to grow more in 
tropical countries, and from that I should make the deduction that 
it would be very much better to have lepers in the colder climate, 
rather than having them in the Tropics. Leprosy, of course, spreads 
wherever it is planted — it makes no difference whether in Greenland 
or Norway or whether it is in Central America or South America 
or where it may be. It seems to spread more in the Tropics than in 
the colder climates. It takes longer to establish the disease in 'the 
colder climates. That is the experience I think which accounts for 
the fact that the disease is very much more frequent in Mexico, for 



28 TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 

example, and in Central America and along the Gulf coast and in 
the West Indies than it is farther north. 

Senator Smoot. On account of sanitary conditions, doubtless. I 
have noticed that people that drink ava freely or live in squalor, par- 
picularly the first, are people that are most affected by leprosy. The 
people I refer to were much addicted to drinking what is called ava, 
which is made from a root. It has a tendency to crack the flesh. I 
have seen the hands of natives cracked wide open. There are many 
cases of that kind that have developed into leprosy. I have thought 
that perhaps that was the basis of bringing on an attack of leprosy, 
through, of course, I think, uncleanly conditions and surroundings. 
That, however, may be only incidental. 

Dr. Dyer. I think that is only incidental. 

The Chairman. Would it be convenient for you to furnish the 
committee with the 30 cases that have been cured ? 

Dr. Dyer. I would have to do it by number and not by name. 

The Chairman. You can do it by number? 

Dr. Dyer. Yes, sir. A report of some of these cases was published 
in 1905. 

The Chairman. I would like to make it a part of our record here. 

Dr. Dyer. I shall be glad to furnish it. 

The Chairman. Please furnish it, so it can be attached to this 
report. 

(The matter referred to was subsequently submitted and is here 
printed in full, as follows:) 

[Extract from "The cure of leprosy," the New York Medical News, July 29, 1905, by 
Isadore Dyer.] 

The results from the use of chaulmoogra oil have been better than ever before, 
and I believe that such oil more nearly approximates a specific for leprosy than 
any treatment as yet suggested. 

During the several years of my observation of leprosy I have acquired cer- 
tain points which I have noted in the treatment of these patients. 

1. Full diet, restricting only indigestible foods is indicated. The disease 
seems in nowise to be affected by fish or any other particular article of diet. 

2. Baths are essential in the treatment. , Hot baths twice a day, with or 
without soda, are effective. 

3. The patient needs tonics, febrifuges, and should be watched for inter- 
current or complicating diseases, such as malarial infection, pleurisy, pneu- 
monia, grippe, and the like. , 

4. Strychnine is a sine qua non in the treatment of leprosy. My assistants 
and I lay down the rule that a leper should always take strychnine — the sort 
and size of dose to be regulated by the patient himself. 

5. When chaulmoogra oil is given it is better endured before meals than 
after. It is best taken in capsules, in hot milk, or in milk of magnesia. The 
dosage should be begun small, say 3 drops, and increased every second or 
third day until as much as 120 to 150 drops of the oil are taken at the dose. 

At times it is advisable to give the oil in pill form. This can be done either 
combining it with extract nux vomica and ordinary excipients, or a very 
effective way is with tragacanth and common soap. 

0. Above all things individualize the patient. Watch for improvement, and 
if it does not show in three months wait six months; if it does not show in six 
months, wait a year or longer. But keep on driving at the treatment until the 
patient dies or gets well. I have on record one patient who did not show any 
signs of improvement for two years, but who is now well. 

7. When all evidences of the disease are gone insist on a continuance of treat- 
ment. It may not be necessary, but it makes sure. 

I am not the first to argue the curability of leprosy. Every center of leprosy 
shows the disease one which runs a natural course. Some cases fulminate and 
destroy the patient in a few months. Other cases are slow in their onset and are 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 29 

slow in their outcome. Yet other cases will show small evidence, which disap- 
pears, leaving no trace and never returning. There are all grades of the dis- 
ease, and the care of each must be as each directs. It only remains for me to 
tabulate those cases of my own which, in my opinion, are cured of the disease. 

Case I. — Lizzie O'C, aged 19 years, first came under observation at the Charity 
Hospital in the early part of 1894. She presented characteristic macules on 
both legs. On her left foot, plantar surface, under the ball of the great toe, 
there was a typical trophic ulcer, with the odor and process characteristic of 
this leprous manifestation. Treatment with strychnine and chaulmoogra oil 
was established. In six months the lesions of the disease disappeared, and after 
more than a year had not returned. 

Case II. — Martin O'C, father of Case I. Disease developed seven years after 
it had appeared in daughter. This case presented the following history : Aged 
62 years ; native of Ireland ; laborer ; seen at Charity Hospital in the fall of 
1895. Lesions presented : One large leprous macule on the forehead ; one on 
the arm of the right side and one on the leg. All of these were uniform in 
size, being about 2 inches in their long and li inches in the shorter diameter. 
The lesions were in the form of irregular ellipses of a dull red color and some- 
what elevated. Anesthesia was marked in each. The eruption had been out 
only a few months, and because of the rapid recovery of the daughter she had 
brought her father for treatment. The evidences of the disease rapidly disap- 
peared under strychnine and chaulmoogra oil. The patient reported for ob- 
servation for six months. 

Case III. — August R., male, aged 47 years; native of Louisiana. Macular 
anesthetic leprosy, torphoneurotic type. Came under observation in April, 1897. 
The antecedent history in this case was clear. Periodic attacks of rheumatoid 
pains in the right arm and forearm were followed by first a sense of numbness 
and then contraction of the fingers. When seen the arm was swollen and the 
ulnar nerve somewhat thickened, with a nodosity the size of a hazelnut just 
below the elbow. 

The last three fingers were contracted and could not be straightened, the 
effort to do so causing pain along the whole forearm. On these three fingers 
there was an eruption of bullae, in size about that of a silver dime ; in number 
four or five. On the dorsum of the hand there were typical anesthetic macules. 
The anesthesia could be well determined fully one-third the way up the ulnar 
side of the forearm. From April 6 to June 22 salicylate of soda, strychnine, 
iodides, were given with varying result so far as the pain was concerned. The 
deformity persisted. On June 28 injections of antivenomous serum was begun. 
In all 11 injections were given in closes varying from 1J to 3 cubic centimeters 
and injected in various points of the body, chiefly along the ulnar nerve and in 
the interscapular area. Total amount injected, 34 \ cubic centimeters. On 
August 30, 1897, the following note was made : " There is faint rosiness over 
base of third finger, at second and third joints and over last phalanx ; the same 
discoloration over the phalanx of little finger. The patient has complete use 
of the hand and forearm and complains only of stiffness at night in the third 
finger. He has improved in general health and weighs 186 against 174 pounds 
at beginning of injections." 

This patient took strychnine sulphate in one-sixtieth grain doses throughout, 
and this was maintained afterwards for some months. In January of 1898 
there was no evidence of the disease, and up to 1902, when patient was last 
seen, there had been no further evidence. 

Case IV. — Henry P., male, 45 years old ; carpenter. Macular anesthetic 
leprosy with trophic changes in left hand. First seen November, 1896, at the 
New Orleans Polyclinic. The evidences of leprosy presented were as follows: 
Face, general duskiness, without distinct lesions. Ears thickened. Back, one 
small macule over the loin. On the right arm a distinct mottled lesion, just at 
the origin of the ulnar nerve ; it was irregular in shape, rather ovid, with the 
long axis running diagonally across the inner aspect of that part of the fore- 
arm. Lesions dark brown, reddish. On the left arm one lesion just at elbow 
joint. On the outer aspect of the arm another lesion like that on the right 
arm. On the flexor surface and inner aspect of this forearm, 3 inches above 
the wrist, a lesion as large as a silver dollar, purplish brown in hue. On the 
third finger, dorsum, deep purplish lesion running the entire length of the 
finger. A similar lesion covered the first phalanx of the second finger. The 
left hand presented the characteristic claw hand. On the right thigh a large 
round lesion 1J inches in diameter. All lesions markedly anestheticf to pain. 

33993°— S. Rept. 306, 64-1 3 



30 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Up to July 7, 1S97, patient had been treated variously with chlorate of potash, 
salicylate of soda, together with strychnine, without result. The strychnine 
was continued and antivenomous serum injections begun on July 7, 1897. A 
total of IS injections were employed, 48| cubic centimeters in all ; maximum in- 
jections, 5 cubic centimeters ; minimum, 1 cubic centimeter. A note made Au- 
gust 30, 1S97, relates that the lesions had disappeared in half their total area. 
The full use of hand restored. All injections had become painful and the 
patient had gained 5 pounds in weight. The injections in this case were kept 
up at less frequent intervals until the spring of 1898, when they were discon- 
tinued because of the difficulty of getting proper serum. The strychnine was 
maintained, however, and the patient reported regularly for observation. In 
June, 1898, he resumed his work as a carpenter, with no evidence of the disease 
left about him and without any recurrence whatever up to 1902. Then he died 
of pneumonia. 

Case V.—K. G., aged 45 years; merchant. Presented July 20, 1S9S, with 
some six leprous tubercles on his face and as many more distributed on differ- 
ent part.- of the trunk and legs. Each of these was fully as large as a small 
marble and characteristic in clinical appearance. One of the tubercles was 
excised and the leper bacillus demonstrated. Patient was put under treatment, 
but inside of three weeks his face was covered with new lesions ; proportion- 
ately as many developed on the rest of the body. As this case had developed 
altogether in less than three months, he was advised to change climate, and 
left New Orleans. He returned at the end of two years, having been subjected 
to very rigorous treatment in Europe, and on my examination was found free 
of the disease. Since 1900 I have seen this patient at regular intervals of four 
or six months, and there has been no evidence in any way whatsoever of a 
recurrence. His treatment consisted in strychnine and chaulmoogra oil. 

Case VI. — Mrs. G. Peterson, aged 27 years. Applied for treatment at the 
Charity Hospital, September 22, 1S99. She presented a deep-seated macular 
leprosy tubercle the size of a silver dollar on the right side of her neck. There 
were two lesions twice this size on each leg. On both hands there were leprous 
nodules and the ulnar nerve on the left side was perceptibly enlarged. Some 
contraction of the two last fingers. Patient took strychnine in one-fiftieth 
grain doses and chaulmoogra oil in increasing doses until 40 drops at the dose 
were taken. In October, 1902, there was no evideuce of the disease. This 
patient has reported regularly at intervals of every four months up to the 
present time, and there has been no recurrence. 

Case VII. — Blanche B., aged 12 years. Reported for treatment July 22, 
1901, presenting a typical lesion the size of a silver quarter over the right 
maxillary region. Another lesion as large as the palm on the right leg. Both 
typical leprous macules. One-sixteenth grain doses of strychnine sulphate and 
increasing doses of chaulmoogra oil were administered. A maximum of 30 
drops was reached. In June, 1902, both lesions had disappeared. Treatment 
was continued until 1903. Patient has reported at intervals since then and 
there has been no recurrence. 

Case VIII. — A. G., aged 33 years; female. History of the disease of 10 
years' standing, progressively increasing until I saw the case. At this time 
the face was covered with ulcerating tubercles; the hands were considerably 
swollen, here and there presenting bulla? and ulcers of typical character. No 
area of the body was free of discoloration, macules, or tubercles. Treatment 
was begun in March, 1901. One-fiftieth grain strychnine sulphate was admin- 
istered three times a day. Chaulmoogra oil was given in increasing doses to 
60 drops three times a day. In addition, arsenic and glycerophosphates were 
administered from time to time. The nose was kept flushed with glycothymo- 
lin and hot baths with corbonate of soda at 95° F. were given twice a day! In 
July, 1903, the patient was free of any leprosy lesion, bacteriological examina- 
tions of secretions and urine proved negative. Up to the present time the 
patient has been bacteriologically examined three times with negative results. 
There has been no recurrence of the disease. 

Case IX. — J. C, aged 13 years. This boy has been the subject of widespread 
newspaper report because of his discharge from the Louisiana Leper Home. 
He was admitted in 1902 as a typical case of tuberculous leprosy. His treat- 
ment consisted in one-sixtieth grain doses of strychnine sulphate and chaul- 
moogra oil up to 100 minims at the dose. His improvement began promptly, 
and at the end of one year the tubercles had disappeared. In June, 1904, 
there were some small areas of pigmentation left. In December, 1904. after 
negative bacteriological examination and the lack of any evidence whatso- 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 31 

ever of the disease, the boy was discharged. He is still kept under observa- 
tion and np to the present time remains well. 

Case X. — S. J., aged 38 years ; native of New Orleans. First seen March 30, 
1898. Typical tuberculous leprosy involving face, hands, legs, and back. The 
patient persistently improved under chaulmoogra oil and strychnine, never 
reaching more than 40 drops of the oil. She has been free of any evidence of 
the disease since 1903. 

It is to be remarked that almost all patients taking chaulmoogra oil have im- 
proved. 

Of the present inmates in the home there are fully a half dozen who have 
improved to the point of certain arrest in the disease ; two of them being now 
kept under observation with the idea of their discharge at no far distant date. 

Dr. Dyer. I will also have other cases furnished from the statistics 
of the Southern Leper Home. 

Senator Works. What is the remedy for leprosy ? 

Dr. Dyer. The remedy for leprosy ? 

Senator Works. Yes. You say there is a remedy. 

Dr. Dyer. Yes. We have used chaulmoogra oil, which has been 
used in India for over 200 years. That has also been used by Dr. 
Heiser and his group of assistants in the Philippines. 

Senator Works. Has no serum been discovered for leprosy ? 

Dr. Dyer. Several of them, but none has proved efficacious. There 
have been five at least. 

Senator Smoot. Have the cases that have been cured been well- 
developed cases, or have they been only in their first stage ? 

Dr. Dyer. Some of the cases were of six or eight years' duration 
when treatment was begun. I think it would be interesting to make 
a part of your record in this matter the report of Dr. Heiser from the 
Public Plealth Service. I am not speaking for the Public Health 
Service, of course; they have representatives here. I think this re- 
port is interesting, though. It was published, I think, in the fall of 
1914. 

The Chairman. We would be glad to do that, Doctor. We are glad 
to have your suggestion. 

Senatbr Smoot. I suppose that report would show the prevalence 
and treatment of the disease in the Philippines. 

Dr. Dyer. Yes ; if the committee desires, I will insert it. 

The Chairman. I wish you would. 

(The report referred to was subsequently submitted, and is here 
printed in full, as follows:) 

Lepeosy — Its Treatment in the Philippine Islands by the Hypodermic Use 
of a Chaulmoogra Oil Mixture. 

[By Victor G. Heiser, surgeon, United States Public Health Service, director of health for 
the Philippine Islands.] 

In the United States Public Health Reports of September 5, 1913, two cases, 
and in the United States Public Health Reports of January 2, 1914, two addi- 
tional cases, or a total of four, were reported as having been apparently cured 
of leprosy and to have remained cured for a period of over two years. The 
first two cases were treated with a mixture of chaulmoogra oil, camphor, and 
resorcin, and in addition they received at irregular intervals a vaccine pre- 
pared in a number of different ways from a strain of so-called leprosy cultures 
of Clegg. The other two cases received only hypodermic injections of the 
chaulmoogra oil mixture, no vaccine being used. The clinical records for the 
above cases, beyond establishing the diagnosis and that they were microscopi- 
cally negative after treatment, were incomplete. With the hope, therefore, of 
having more satisfactory data available, 12 cases, which included the different 
types of leprosy, were placed under treatment February 21, 1912, with the same 



32 TEEATMENT OP PERSONS AFFLICTED WITH LEPEOSY. 

ehnulmoogra oil mixture as was used in the cases already reported as ap- 
parently cured. The object of this paper is to present the results that were 
obtained. 



Statistical summary. 

Cases placed under treatment 12 

Cases taking treatment throughout period 9 

Cases apparently recovered and microscopically negative 1 

Cases in which clinical evidence of leprpsy practically disappeared 4 

Cases showing only slight evidences of improvement 1 

Cases declining to take prescribed treatment 3 

NET RESULTS. Per cent. 

Apparent cures H- H 

Apparent clinical recoveries 44. 44 

Showing marked improvement 33. 33 

Showing only slight evidence of improvement 11. 11 

BRIEF REVIEW OE THE STEPS LEADING TO THE PRESENT TREATMENT. 

It has been customary in the Philippine Islands to try any treatment for 
leprosy that came to the attention of the bureau of health and in the employ- 
ment of which we could satisfy ourselves that no harm would be done the 
patient. We have always been very fortunate in having volunteers for any 
form of treatment which it was proposed to try. Most of the remedies had no 
noticeable effect. However, some apparent cures have resulted from time to 
time with the different treatments used. For instance, several lepers were 
apparently cured by the use of the X ray ; others were apparently cured by the 
administration of crud chaulmoogra oil by mouth, but regardless of the treat- 
ment used the disease always returned before the expiration of a year. In view 
of this experience, it was deemed advisable to wait for a period of two years 
before reporting apparent cures. That a period of two years, or perhaps even 
a longer time, should elapse before a case may be considered as cured is well 
illustrated by Case I. Reference to the microscopical record shows that this 
case was negative from May 19, 1913, to February, 1914. April 15, 1914, it 
was positive again, and this in spite of the fact that the physical signs of 
leprosy have not returned. 

Chaulmoogra oil by mouth has been used at the San Lazaro Hospital since 
the early years of American occupation of the Philippine Islands. In 1907 
©ur attention was directed to the success which was had by Dyer, of New 
Orleans, in the treatment of leprosy with chaulmoogra oil. In 190S a confer- 
ence was had with him and through his courtesy Dr. Hopkins showed us the 
cases that had been treated by Dr. Dyer's method at the Iberville Parish Leper 
Colony, as well as the practical details for administering the oil, the strych- 
nine, and the sodium bicarbonate baths. 

Cases were soon afterwards treated at the San Lazaro Hospital, Manila, by 
Dyer's method and much more success was had than formerly. Unfortunately, 
lowever, on account of the great nausea which was produced, very few cases 
were able to take the oil for a period of more than a few months. Every 
effort was then made to find a way by which the oil might be given without 
causing this untoward effect. Various preparations of the oil in which the 
emetic principle had been removed were tried, but these apparently had no 
influence on the disease. Emulsions of different kinds were prepared. Cap- 
sules were coated with various substances with the idea of having them pass 
through the stomach unaltered, but nausea continued to occur and scarcely 
anyone could be induced to take chaulmoogra oil for a longer period than 
three months on account of the nausea. The few who persisted beyond this 
period usually showed great improvement and a few apparent cures took 
place. Enemas of chaulmoogra oil were also tried, but they had no apparent 
influence on the disease. 

A review of the literature showed that the oil had been used hypodermically. 
That method was then tried, but great difficulty was had owing to the failure 
©f the oil to be absorbed. To overcome this difficulty the Merck Co. suggested 
that chaulmoogra oil might be combined with ether or camphor. The sug- 
gestion was put into effect and it was found that camphor gave the best re- 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 33 

suits. It then occurred to Dr. Mercado, the house physician at the San Lazaro 
Leper Hospital, to combine the camphor with the resorcin prescription of 
Unna. The mixture was prepared as follows: 

Chaulmoogra oil : c. c 60 

Camphorated oil c. c 60 

Resorcin grams— 4 

Mix and dissolve with the aid of heat on a water bath and then filter. 

Soon after this mixture was used hypodermically over a period of several 
months, noticeable improvement took place in the appearance of the lesions 
and in the general health. The treatment was irregularly used on a number 
of cases. Among others, two lepers took it who had previously been treated 
without success with a vaccine made with bacilli grown in accordance with 
the method of Clegg. These two cases recovered early in 1911, after a few 
months' treatment and apparently remained completely cured for a period, of 
two years, when they were discharged from the hospital on probation. Later, 
two additional cases recovered that had no other form of treatment except 
the hypodermic injections of the chaulmoogra oil mixture, from which it 
seems reasonable to infer that the vaccine had had no effect in the first two 
cases. 

KIND OF OIL L T SED. 

On account of the question raised recently in a number of medical journals 
as to the genuineness of much of the chaulmoogra oil on the market at present, 
a sample of oil was purchased in the open market of Manila and a sample 
of oil was secured from the Indian Forests Economic Products Co. (Ltd.), of 
Chittagong, India. Both of these samples were sent to the bureau of science 
for analysis, with the following result : 



Standard. 


Indian. 


Stock. 




/ (at25°C.) 
\ 0.951 
1.478 
. 213.0 
103.0 


(at 30° C.) 
0. 9466 
1.478 
212.9 
102.2 


(at 30° C.) 

0.9543 










103.5 







There is little choice, both oils being close in their constants to the standard 
oils. 

A. H. Wells, Analyst. 
H. C. B. 

The oil used in the tratement of the cases reported in this paper was that 
referred to in the foregoing analysis report as " stock." 

Experience with chaulmoogra oil at San Lazaro Hospital, when administered 
by mouth, has shown that the crude oil is much more efficacious than the re- 
fined product. When used hypodermically there is apparently no difference 
whether the crude or the refined oil is used, but accurate data with regard 
to this point are not yet available. 

DETAILS OF TREATMENT. 

The injections are usually made at weekly intervals in ascending doses. 
The initial dose is 1 c. c, and this is increased to the point of tolerance. Much 
difference exists among the cases as to the amount of the mixture which they 
are able to take. In some cases a few cubic centimeters produce marked re-. 
actions in the lesions, accompanied by fever and cardiac distress. Sometimes 
it is better to reduce the amount of the dose and inject at more frequent in- 
tervals. The object sought is so to regulate the dose as to prevent reactions 
of too violent a character. Quicker results are also apparently obtained when 
it is possible to inject the mixture into large leprous deposits or to divide the 
dose by injecting it into a number of smaller infiltrations. Experience so, far 
leads to the inference that with additional study the prospects seem fair for 
greatly improving upon the results that are obtained at present. Attention is 
drawn to the fact that no strychnine was used. Many writers have regarded 
strychnine as an essential part of the chaulmoogra-oil treatment. Saline purga- 
tives are freely employed. Two per cent hot sodium bicarbonate tub baths are 



34 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

prescribed every other clay. Those who take prolonged baths regularly seem 
to improve more rapidly than those who do not. 

******* 

CONCLUSION. 

The present stage of the development of the treatment herein described 
does not warrant a claim that anything like a specific for leprosy has been 
found, but experience does show that it gives more consistently favorable 
results than any other that has come to our attention, and it holds out the 
hope that further improvement may be brought about. It produces apparent 
cures in some cases, causes great improvement in many others, and arrests 
the progress of the disease in almost every instance. We have on hand at 
present over 20 persons who have become microscopically negative since they 
began the treatment. The treatment is apparently equally efficacious in all 
forms of the disease; that is, the tubercular or hypertrophic, the anaesthetic 
and the mixed. A series of cases is now undergoing the treatment for the 
purpose of more accurate study of its effect in the different forms of the 
disease and whether any difference exists as to sex. Experience also shows 
the great desirability of further trial in the hands of other workers in different 
parts of the world, with the hope that improvements may result. Finally, it 
is always important to remember that there are many treatments for leprosy 
which apparently cause some improvement, and it not infrequently happens 
that when cases of leprosy are placed under better hygienic conditions and 
have hospital care, or for other reasons not understood, the disease is often 
arrested, in a few instances improvement results, and that apparent cures 
may take place without any treatment. 

Senator Beckham. How is that chaulmoogra oil, Doctor, as a 
remedy ? 

Dr. Dyer. It seems to be very efficacous in ameliorating the symp- 
toms of leprosy, even when it does not wholly effect a cure. 

Senator Beckham. How is it given ? 

Dr. Dyer. We give it by the mouth, while in the Philippines they 
give it by the hypodermic method. At the leper home in Louisiana 
none of the patients has been forced to undergo treatment, and most 
of them object to the hypodermic method, so we have little experience 
with the Heiser method. 

The Chairman. You say that a patient sometimes resists treat- 
ment for a long time ? 

Dr. Dyer. Yes, sir; sometimes for five or six years. Any leper 
that has not advanced to the point of a destructive stage is amenable 
to treatment. As to whether lie w T ill get well or not depends en- 
tirely upon his own ability to take treatment. My own belief is that 
if patients with leprosy were placed in an institution where the 
treatment could be made systematically and under the direction of 
an efficient medical force, which the Louisiana home has not — it has 
a visiting physician who is qualified, but who is not paid enough to 
devote his whole time to the work — they would almost always re- 
cover, if taken early. My own belief is that 50 or 60 per cent of 
them could get well. 

I will prepare a list of the cases discharged as cured from the 
Louisiana Lepers' Home. 

(The list referred to was subsequently submitted, and is here 
printed in full, as follows:) 

New Orleans, March .',, 1916. 

Dr. Is ADORE DVER, 

12?i Baronne Street, New Orleans. 
Dear Doctor: In reply to your communication concerning the cases dis- 
charged as cured from the lepers' home, I trust the following brief report will 
contain the desired information: 



TREATMENT OP PERSONS APPLICTED WITH LEPROSY. 35 

1. Hospital record 44. Female; age 50; white; admitted August 10, 1899; 
discharged November 28, 1905. 

2. Hospital record 62. Male; age 39; white; admitted March 7, 1902; dis- 
charged May 27, 1910. 

3. Hospital record 84. Female ; age 48 ; white ; admitted June 6, 1904 ; dis- 
charged May 1, 1906. 

4. Hospital record 89. Female ; age 45 ; white ; admitted September 15, 1904 ; 
discharged September 19, 1911. 

5. Hospital record 94. Male ; age 70 ; colored ; admitted April 12, 1905 ; dis- 
charged September 5, 1906. 

6. Hospital record 106. Female; age 14; white; admitted May 6, 1906; dis- 
charged December 17, 1909. 

7. Hospital record 163. Female ; age 35 ; white ; admitted November 20, 
1910 ; discharged December 5, 1912. 

8. Hospital record 182. Female; age 53; white; admitted March 13, 1912, 
discharged July 31, 1914. 

9. Hospital record 185. Female ; age 65 ; white ; admitted May 23, 1912 ; dis- 
charged October 21, 1914. 

10. Hospital record 199. Male; age 46; white; admitted April 17, 1913; 
discharged November 19, 1915. 

11. Hospital record 205. Male ; age 11 ; white ; admitted June 18, 1913 ; dis- 
charged December 7, 1913. 

12. Hospital record 220 : Female ; age 52 ; white ; admitted April 8, 1914 ; 
discharged June 10, 1915. 

13. Hospital record 221: Female; age 58; white; admitted April 8, 1914; 
discharged April 8, 1915. 

Note. — Age stated here indicates age at the time of admission. 
All of the above cases were admitted to the home while still in the incipient 
stage of leprosy, and were treated with chaulmoogra oil given internally in 
doses of from 3 to about 100 drops three times daily. The oil was given in cap- 
sules and the doses gradually increased to the maximum, according to the toler- 
ance of the individual. Strychnine was also given in moderate doses three 
times daily, and daily prolonged hot baths. 

Cases were discharged when no clinical evidences of leprosy remained and no 
acid-fast bacilli could be found in the seat of old lesions or in the nasal 
secretions. 

Respectfully, yours, 

Ralph Hopkins, M. D., 
Attending Physician of Leper's Home of Louisiana. 

The Chairman. You said that in Louisiana there were probably 
315 lepers, and that your investigations had discovered in the neigh- 
borhood of 400 known cases in the United States. 

Dr. Dyer. That was several years ago. 

The Chairman. Several years ago? 

Dr. Dyer. Yes; 1904. 

The Chairman. From the best information you have how many 
lepers are there in the United States, in your judgment? Just give 
us an estimate. 

Dr. Dyer. I should, of course, have to estimate it. I think there 
are from 800 to 1,200 cases in the United States. I am only judging 
that upon the proportionate development of the disease in Louisiana, 
even Avhen the disease is under control. Of course the increase would 
be greater if the disease has been allowed growth, absolute growth, 
such as in a place like New York, where it has been known for the 
last 30 or 40 years, and where it has grown and developed without 
restraint. 

Senator Smoot. There are sections of the country free from it, are 
there not ? 

Dr. Dyer. Oh, yes; there are cases reported in Oregon and Cali- 
fornia; but when you come East, to the Dakotas, you will probably 
find that they are free from disease, as are also probably Wyoming 



36 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

and Montana; but when you get down to Arkansas you find an occa- 
sional report of a case. There are cases occasionally reported also 
in Illinois, Iowa, and in Kansas, and up to Minnesota. Cases have 
been reported in Virginia, Ohio, Maryland, and in the Carolinas. 

Senator Beckham. And in Kentucky? 

Dr. Dyer. Yes; we know there are cases in Texas, Louisiana, 
Florida, and Mississippi. 

Senator Beckham. How many of those could probably be gath- 
ered together voluntarily in a common sanatorium ? 

Dr. Dyer. I think that would depend on the way the institution 
was presented to the public. If it were presented as an institution, 
where an attempt was made to cure leprosy and where all provi- 
sions of a sanatorium were offered, I think most of them would go 
in voluntarily. 

Senator Beckham. You believe in making it compulsory? 

Dr. Dyer. It would be rather hard to make it compulsory under 
governmental administration. 

Senator Beckham. What leads you to say that ? 

Dr. Dyer. I have come to learn how the patient views the matter, 
from my experience in Louisiana. 

Senator Works. The power of the National Government in this 
matter is a serious question. It is a serious question how far the 
Federal Government should go. It is a question whether the Gov- 
ernment would have the power to make a citizen travel from one 
State into another. 

The Chairman. I think it would be constitutional for the States 
to pass laws requiring their citizens to go to such a sanatorium. 
What do you think about that. Doctor? 

Dr. Dyer. Of course, Mr. Chairman, I am not a lawyer, and I 
would not like to express an opinion on that. You gentlemen are 
better prepared to do so than I am. 

The Chairman. Do you think your State would have the power 
to require your citizens to go to such a sanatorium as this bill pro- 
poses ? 

Dr. Dyer. That is a question I shall have to leave to the lawyers. 

Senator Works. That is a question on which even lawyers might 
differ. 

Senator Smoot. Yes. 

The Chairman. I think we shall not be able to settle that here 
to-day. 

Dr. Dyer. You have some representatives here from the American 
Medical Association, which has indorsed this bill. 

The Chairman. I was going to ask you if this measure, or one 
similar to it, had the indorsement of the medical profession of the 
United States. 

Dr. Dyer. So far as I know, it is indorsed by the medical profes- 
sion. There are other gentlemen here who can speak perhaps more 
fully on that than I can. I should be glad to help on any other 
point, however. 

The Chairman. Do you regard the establishment of the home in 
Louisiana as a very wise and beneficial institution in that State? 

Dr. Dyer. Oh, yes, sir. I was individually responsible for it. 
Leprosy in Louisiana in 1894 had no status beyond the fact that 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 3? 

lepers were objects of law. The law made no provision for their 
care. The contractor who took care of smallpox patients furnished 
for the lepers a building not in use at that time for smallpox. They 
were there in a very miserable state, The State legislature, as soon 
as the case was presented, saw the desirability of having some ade- 
quate provision for taking care of the lepers, both for the benefit of 
the lepers themselves and for the protection of the public. 

The Chairman. The treatment you give the lepers is very humane ? 

Dr. Dyer. Yes, sir. 

The Chairman. Doctor, you make the lot of the leper about as 
happy as that of any unfortunate being could be, do you not ? 

Dr. Dyer. Yes, sir. 

The Chairman. Is it your opinion, Doctor, that the establishment 
of that home and the care that is given there and the study that is 
made of the disease will have a very great tendency to prevent the 
spread of leprosy in Louisiana and gradually to eradicate it? 

Dr. Dyer. Yes, sir. It is difficult to tell how many cases there 
might have been in Louisiana had the State not taken these steps. 
The institution was started in 1894. It has cared for more than 300 
cases. 

Senator Works. Suppose the National Government proposes to 
take over your institution and convert it into a national sanatorium, 
do you think that would be satisfactory to your people ? 

Dr. Dyer. You mean to the people of Louisiana ? 

Senator Works. Yes. That would cover all the lepers in your 
State. 

Dr. Dyer. I should individually feel that that was not the best 
solution, in that you would simply be making a larger nest of the 
disease in a community that is already rather full of it. 

Senator Works. You will find that difficulty everywhere. Every 
section of the country will object to the location of a sanatorium of 
that kind in it. 

Dr. Dyer. In locating a home in Louisiana we tried several sites 
before we got one that Avas suitable. 

Senator Works. That is what the Government will try to do. 

The Chairman. What would be the probable effect in the United 
States if some action — some concerted action — is not taken by the 
States themselves, or by the National Government, toward segre- 
gating the lepers and treating them systematically and properly. 

Dr. Dyer. The answer to that would be that the number of cases 
would gradually increase until it would become necessary to make 
some provision for them. That has been the experience of every 
country. As long ago as the year 1897 the question was raised at 
the Berlin Leprosy Conference and I think the United States was 
the only one of the more modern civilized countries that had not 
made provision. In Japan they had a number of leprosaria. In 
some of the States of South America, notably the United States of 
Colombia, they have made provision. In Cuba they have a leper 
hospital and have had for a number of years. They also have 
one in Porto Rico. In Jamaica they have isolated their lepers for a 
number of years. They also isolate their lepers in Canada. 

The Chairman. How is it in the European countries? 

Dr. Dyer. They have made provisions in all the European coun- 
tries. Of course leprosy has gradually died out there. In Germany 



38 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

there were some cases. In France there was not a great number of 
cases. The cases were rather concentrated around the Mediterranean, 
in the Levant and in the Orient. 

The Chairman. Has there been a system formed in Europe to 
segregate lepers and prevent the spread of the disease? 

Dr. Dyer. Yes; at the Berlin conference in 1897, all of the coun- 
tries represented reported the care of lepers and the statistical occur- 
rence of the disease. 

Senator Works. I suppose there would be just as much reason and 
obligation on the part of a State to take care of its lepers as there 
is for it to take care of its insane. The States are all caring for their 
insane, and it would seem as if they ought to take as much interest 
in caring for their lepers, because they are more dangerous to the 
State than insane persons are in a great many ways. 

Dr. Dyer. In Louisiana the law pertaining to the control of lepers 
is identical with the law pertaining to the insane. Of course leprosy 
presents a little different problem. All the States have their insane, 
and their condition may be purely temporary, of course. With lep- 
rosy the question enters also as to the importation of the disease, 
which has not been seriously considered here this morning. So long 
as we are sending our representatives and citizens to extraterritorial 
possessions, they are not only liable to contract the disease there, but 
to bring it back with them to this country. It would be a great hard- 
ship upon United States citizens to be kept out of their own country 
on account of a disease which they contracted while in the service of 
their country in a foreign land. 

Senator Works. We could not very well keep one of our own 
citizens out of the country. 

Dr. Dyer. That is a question to be considered. 

The Chairman. We have one here — John Early. 

Dr. Dyer. Yes. 

The Chairman. If there are no further questions, we will excuse 
Dr. Dyer. 

Dr. Dyer. Thank 3 7 ou. 

The Chairman. Doctor, we are very much obliged to you. I will 
now ask Dr. Howard Fox to give us his views. 

STATEMENT OF DR. HOWARD FOX, CLINICAL PROFESSOR OF 
DERMATOLOGY NEW YORK POLYCLINIC MEDICAL SCHOOL; 
ATTENDING DERMATOLOGIST HARLEM AND WILLARD PARKER 
HOSPITALS; PRESIDENT NEW YORK DERMATOLOGICAL SO- 
CIETY; VICE PRESIDENT AMERICAN DERMATOLOGICAL ASSO- 
CIATION. 

The Chairman. Doctor, will you state in your own way any points 
you can make in regard to such an institution as is suggested by this 
bill, and the experience you have had with leprosy in the United 
States? 

Dr. Fox. Before speaking about the bill in question I would like 
to say one or two words as to whether leprosy presents a real public- 
health problem for the United States. 

In the first place, no one can deny that leprosy is a very terrible 
disease, frequently loathsome, mutilating, and I feel that in only a 
very small percentage of cases is the disease curable. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 39 

In the second place, I do not think there is any doubt that leprosy 
is contagious. It is true that the disease may require a great many 
years to make its symptoms apparent — even as long as 20 or 30 years. 
In spite of the fact that we do not know how it is carried from person 
to person, I think it is agreed that it is a contagious disease. 

Leprosy is prevalent to some extent in the United States, it being 
estimated" that there are between 500 and 1,000 cases. The exact 
number is very hard to determine. Many of them are imported. A 
great many cases do arise, however, in persons that have never been 
outside of the United States. It seems to me that if we continue to 
have the present number of cases, and no more, leprosy would still 
be a serious problem for the United States. No one can deny, how- 
ever, that at some time in the future leprosy will suddenly increase 
in this country, as it has done in the Hawaiian Islands and a great 
many other countries of the world, and gain a strong foothold and 
become a serious and terrible problem with which to grapple. 

If we agree that leprosy is a real serious health problem, it seems 
to me that the formation of a national leprosarium would be the best 
means of solving this problem. In the first place, it would protect 
the public health against leprosy ; second, it would insure decent and 
humane treatment for the lepers themselves ; and, in the third place, 
it would have economical advantages. 

in regard to protecting the public health against leprosy, history 
shows that the only method of eradicating leprosy from any com- 
munity is by segregation. Under the present system it is practically 
impossible to do this, owing to the utter lack of uniformity in the 
laws of the different States. For instance, Pennsylvania and Massa- 
chusetts have, I believe, rather stringent laws against lepers, while 
the Board of Health of New York has very lax laws. Consequently 
there are very few lepers in Pennsylvania or Massachusetts, while 
there are many of them in New York State. I stated at a meeting 
of the Academy of Medicine six years ago that I had personally 
examined 30 cases of leprosy in New York City in the course of one 
year. It is posssible that there are 50 or more cases in New York 
City all the time. 

Senator Smoot. Do you know what percentage of decrease there 
has been in the number of lepers of the island of Molokai from the 
highest number down to the number there to-day ? 

Dr. Fox. No, sir ; I am not familiar with those figures. 

Senator Smoot. I was over there last year, and I was told that 
they had decreased since the segregation took place. From the time 
the largest number was segregated down to to-day there was over 
50 per cent decrease. 

Dr. Fox. I do not know the figures in the Hawaiian Islands, but 
that has been the rule all over the world. In the twelfth and thir- 
teenth centuries in France there were, I think, 2,000 leprosaria for 
these unfortunates. After segregation had been practiced for some 
time leprosy became practically unknown. 

The second point I want to mention is that the passage of this, bill 
would insure decent and humane treatment for lepers. Everyone 
knows how at present lepers are fairly hounded from one State to 
another. A certain case about which we have all read was due more 
or less to public hysteria, and would not have occurred if the problem 
had been handled properly by the Federal Government. Further- 



40 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

more, if all the lepers were brought together in one institution their 
lot would be bearable at least. It would not be so bad as it is now, 
where two or three, often of different nationality, are isolated in 
some lonely spot. 

Senator Works. Misery loves company. 

Dr. Fox. Yes, sir. In the next place, this system would be eco- 
nomical. Of course, it is apparent that the cost of taking care of 
the lepers under one institution would be more economical than in 
caring for them in a large number of small institution.s 

The Chairman. What is the possibility of a very much more 
scientific study and investigation of the disease where a large number 
are segregated in one place than under the present system, where 
they are very much more scattered? 

Dr. Fox. Of course, that would be another advantage that such 
a leprosarium would have. 

The Chairman. As I understand it, Doctor, you would favor such 
a bill as this ? 

Dr. Fox. I am absolutely heart and soul in favor of the passage 
of such a bill. 

The Chairman. Is it reasonable to suppose that your State is going 
to create such a leprosarium very soon? 

Dr. Fox. I do not see very many signs of interest in it one way or 
the other. 

The Chairman. How long have you had leprosy in New York, so 
far as the records show ? 

Dr. Fox. The transactions of our dermatological society show that 
the disease has existed there for nearly 50 years. 

The Chairman. You say there may be 50 or more cases in New 
York City all the time? You have not the exact record? 

Dr. Fox. No, sir ; I have not the exact record. 

The Chairman. Have you aiiy idea how many there are in the 
State? 

Dr. Fox. I suppose the majority of them are in New York City, 
because they are less conspicuous than in the country. 

The Chairman. Of the 30 which you examined, how many were 
foreign born ? 

Dr. Fox. Most of them were foreign born. 

The Chairman. That is one of the things that makes it a national 
problem, that a great many of our cases come from abroad, is it not ? 

Dr. Fox. Yes, sir. 

Senator Works. It is for the National Government to say whether 
they shall be admitted or not, but once they have been admitted and 
become citizens of a State, that is another question. 

The Chairman. Is it very hard, Doctor, to determine whether or 
not a person has leprosy? 

Dr. Fox. It is absolutely impossible at times. 

The Chairman. You say the disease does not show itself for 
some time ? 

Dr. Fox. From 10 to 15 to 20 years, sometimes. 

The Chairman. Can you give us some of those terrible cases you 
speak of. sending them to me to insert ? 

Dr. Fox. Yes, sir. 

The Chairman. We should also 1 e glad to have you insert in the 
record some material on the diagnosis of leprosy. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 41 

(The matter referred to was subsequently submitted, and is here 
printed in full, as follows :) 

The Wasseemann and Noguchi Complement-Fixation Test in Leprosy. 
[By Howard Fox, M. D., of New York.] 

The first to obtain a positive Wassermann reaction in a case of leprosy was 
Eitner in 1906. A similar report was made by Weichselmann and Meier nearly 
two years later. Since then it has been found by a number of observers that 
leprosy quite frequently gives a positive reaction. In testing 26 advanced 
cases of the disease Slatineanu and Danielopolu found 20 strongly positive, 
4 moderately positive, and 2 weakly positive reactions. Jundell, Almkvist, 
and Sandman in a series of 26 cases obtained 4 strong and 4 moderately posi- 
tive reactions. In 2 cases the result was unsatisfactory, while in the re- 
maining 16 cases the reaction was negative. Of the positive cases 5 were 
of the tubercular and 3 of the maculo-anesthetic type. From this Sand- 
man concludes that the occurrence of the reaction does not depend upon the 
type of the disease, whether tubercular or anesthetic. Meier, on the other hand, 
in a series of 28 cases found positive reactions only in the tubercular type of 
leprosy. All of the anesthetic cases gave negative reactions. The number of 
cases of each type was unfortunately not stated. Similar results were obtained 
by Bruck and Gessner, who found positive reactions in 5 out of 7 tubercular 
cases and negative reactions in 3 anesthetic cases. Positive reactions have also 
been obtained by Gaucher and Abrami in 8 cases and by Frugoni and Pisani in 
9 out of 11 cases of leprosy, the type of the disease, however, not being stated. 

Eitner was also the first to obtain complement fixation in leprosy, using an 
extract of leprous tissue as antigen. Similar results were later reported by 
Slatineanu and Danielopolu, Gaucher and Abrami Sugai, Pasini, and by Frugoni 
and Pisani. It was also found by Slatineanu and Danielopolu that complement 
could be fixed by leprous serum employing tuberculin as antigen. Complement 
fixation in leprosy was also obtained by Frugoni and Pisani by using tuberculin, 
tubercle bacilli, and extracts of sarcoma and carcinoma as antigen. 

It has been my privilege during the past six months to have employed the 
Wassermann reaction in 60 cases of leprosy. Fifteen of these cases were seen 
in various clinics and hospitals in New York City. The remaining 45 were seen 
during a recent visit to the Leper Home in Louisiana, an institution under the 
direction of Dr. Isadore Dyer, of New Orleans. All of these 15 cases, with 
one exception, were tested by both the regular Wassermann and the Noguchi 
methods, the results in all cases being identical. The cases in Louisiana were 
tested alone by the more convenient method of Noguchi, owing to lack of time 
at my disposal. The technique used was the same as that described in some 
of my previous communications, and will be here omitted for the sake of brevity. 
It may, however, be remarked that the antigen used in the Wassermann test 
was an alcoholic extract of syphilitic liver. The antigen used in the Noguchi 
test consisted of acetone insoluble lipoids. The patient's serum in the Noguchi 
method was used in active condition. All of the cases examined were un- 
doubted lepers, many of them having been under observation for years. No 
history of syphilis was obtainable in any case. Certainly no lesions were seen 
in any patient that could have been regarded as syphilitic. 

To summarize the results of the 38 cases of the tubercular and mixed type, 
the reaction was negative in 7, weakly positive in 3, positive in 21, and strongly 
positive in 7 cases. Of the 22 maculo-anesthetic and purely anesthetic cases 
the reaction was negative in 19, strongly positive in 1, and positive in 2 cases. 

It may be of interest to add that beside the 15 cases of leprosy examined in 
New York I have also seen or personally known during the past six months 
of 7 other cases (3 of Dr. J. McF. Winfield, and 1 each of Drs. William B. 
Trimble, M. B. Parounagian, F. M. Dearborn, and G. H. Fox). It will doubt- 
less seem surprising to some that there should have been so many cases of 
leprosy in New York City during such a short space of time. 

cases of tubercular and mixed type with positive reaction. 

Case 1 : Patient of Dr. S. Dana Hubbard, service of Dr. Jackson, Vanderbilt 
Clinic. I. W.. West Indian negress, aged 33 years. Advanced case of tuber- 
cular type. Duration of disease, two years. Reaction: Strongly positive. 



42 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Case 2 : Patient of Dr. G. H. Fox, New York Skin and Cancer Hospital. 
S. V.. man, aged 40 years, born in Russia. Active fairly advanced case of 
mixed type. Duration, two years. Reaction : Strongly positive. 

Case 3: Patient of Dr. G. H. Fox, New York Skin and Cancer Hospital. 
P. N., man, aged 42 years, Italian, Armenian. Advanced case of mixed type. 
Duration said to be two years. Reaction : Strongly positive. 

Case 4: Patient of Dr. G. H. Fox, New York Skin and Cancer Hospital. 
S. V., man, aged 27 years, Italian. Very marked active case of tubercular type. 
Duration, three years. Reaction : Positive. 

Case 5 : Patient of Dr. L. Duncan Bulkley, New York Skin and Cancer 
Hospital. R. R., Russian woman, aged 60 years. Advanced case of mixed 
type. Duration, 10 years. Reaction : Positive. 

Case 6: Patient of Dr. J. McF. Wintield, Kings County Hospital. C. W., 
negro, aged 2G years, born in United States. Mixed type of moderate severity, 
of eight years' duration. Reaction: Positive. 

Case 7: Patient of Dr. J. McF. Winfield, Kings County Hospital. L. M., 
man, aged about 50 years, Russian. Advanced case of mixed type. Duration, 
about 20 years. Reaction : Positive. 

Case 8 : Patient of Dr. F. M. Dearborn, Metropolitan Hospital. P. L., China- 
man, aged 39 years. Advanced active case of mixed type. Duration, six years. 
Reaction : Positive. 

Case 9: Patient of Dr. William S. Gottheil, City Hospital. Chinaman, 
aged 29 years. Moderate case of tubercular type, of four years' duration. 
Reaction : Weakly positive. 

Case 10: Patient of Dr. William S. Gottheil, City Hospital. E. G., man, 
aged 27 years, born in Russia. Mild case of tubercular type. Duration, three 
and a half years. Reaction : Positive. 

Case 11: Patient of Dr. L. Oulman, German Hospital. L. T., woman, aged 
24 years, born in Russia. Case of mixed type of moderate severity. Duration, 
nine years. Reaction : Strongly positive. 

Case 12 : Colored woman, aged 57 years. Active tubercular case. Duration 
of disease, four years. Reaction: Positive. 

Case 13 : White woman, aged 48 years. Advanced case of mixed type. Dura- 
tion, 14 years. Reaction : Positive. 

Case 14: White woman, aged 27 years. Case of mixed type. Duration, 
seven years. Patient improving. Reaction: Weakly positive. 

Case' 15 : White woman, aged 50 years. Mixed type of the disease in an 
advanced stage. Reaction : Positive. 

Case 16 : White woman, aged 40 years. Advanced and active case of mixed 
type. Reaction : Positive. 

Case 17: Colored woman, aged 50 years. Advanced case of tubercular type. 
Duration of disease, three years. Reaction : Positive. 

Case IS : White boy, aged 16 years. Case of tubercular type. Duration, 
nine years. Reaction : Positive. 

Case 19 : White man, aged 48 years. Incipient type, in which the disease is 
active. Duration, five years. Reaction : Strongly positive. 

Case 20 : White man, aged 45 years. Advanced case of mixed type. Dura- 
tion, 17 years. Reaction : Positive. 

Case 21 : Colored man, aged 48 years. Advanced case of mixed type, in 
which process is stationary. Duration, four years. Reaction : Positive. 

Case 22 : Colored man, aged 37 years. Active case of tubercular type. Dura- 
tion, five years. Reaction : Weakly positive. 

Case 23 : Colored man, aged 50 years. Advanced case of mixed type. Dis- 
ease active. Duration, five years. Reaction : Strongly positive. 

Case 24 : White boy, aged IS years. Terminal case of tubercular type, with 
active lesions. Duration, 12 years. Reaction : Positive. 

Case 25: White boy, aged 19 years. Advanced case of mixed type. Dura- 
tion, five years. Reaction : Positive. 

Case 20: White boy. aged 16 years. Advanced case of mixed type. Dura- 
tion, four years. Reaction : Positive. 

Case 27: White boy, aged 20 years. Incipient case of mixed type, relapsing 
after apparent cure. Duration, nine years. Reaction : Strongly positive. 

Case 28 : Colored man, aged 42 years. Terminal stage of mixed type. Dura- 
tion, three years. Reaction : Positive. 

Case 29 : White woman, aged 35 years. Advanced active case of mixed type. 
Duration, 14 years. Reaction: Positive. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 43 

Case 30: White woman, aged 57 years. Advanced case of mixed type, 
tubercles having disappeared. Duration, 20 years. Reaction : Positive. 

Case 81 : White man, aged 40 years. Terminal stage of mixed type. Duration, 
eight years. Reaction : Positive. 

CASES OF TUBEECULAB AND MIXED TYPE WITH NEGATIVE EEACTION. 

Case 32: Patient of Dr. William S. Gottheil, City Hospital. H. S., man, 
aged 33 years, born in the United States. Case of mixed type of moderate 
severity. Duration, 10 years. Reaction : Negative. 

Case 33 : Patient of Dr. F. M. Dearborn, Metropolitan Hospital. J. M., man, 
aged 50 years, born in Russian Poland. Case of mixed type. Very few lesions 
at present, though formerly well marked. Duration of disease not known. 
Has been in leper ward for the past six years. Reaction : Negative. 

Case 34 : White man, aged 28 years. Mixed type. Patient improving. Dura- 
tion of disease, IS years. Reaction : Negative. 

Case 35 : White man, aged 21 years. Incipient case of mixed type, which 
is improving. Duration, six years. Reaction : Negative. 

Case 36 : White man, aged 24 years. Advanced case of mixed type. Disease 
active. Duration, 18 years. Reaction: Negative. 

Case 37 : Colored man, aged 26 years. Terminal case of mixed type. Dura- 
tion, probably five years. Reaction : Negative. 

Case 38 : White woman, aged 43 years. Case of mixed type, improving, 
tubercles having disappeared. Duration, 20 years. Reaction : Negative. 

CASES OE MACULO-ANESTHETIC TYPE WITH POSITIVE EEACTION. 

Case 39: Patient of Dr. G. H. Fox, New York Skin and Cancer Hospital, 
T. D., girl, born in Key West, Fla. Maculo-anesthetic case of one year's dura- 
tion. Reaction : Positive. 

Case 40: Colored woman, aged 64 years. Incipient anesthetic case. Dura- 
tion, three years. Reaction : Strongly positive. 

Case 41 : Colored woman, aged 59 years. Maculo-anesthetic case, improving. 
Duration, two years. Reaction: Positive. 

CASES OE MACULO-ANESTHETIC TYP] WITH NEGATIVE EEACTION. 

Case 42: Patient of Dr. J. McF. Winneld, Kings County Hospital. J. D., 
West Indian negro, aged 29 years. Maculo-anesthetic type. Duration, about 
23 years. Reaction: Negative. 

Case 43 : White girl, aged 17 years. Incipient case of maculo-anesthetic type. 
Duration, 14 years. Reaction: Negative. 

Case 44: White woman, aged about 60 years. Anesthetic type in advanced 
stage. Duration of the disease, unknown. Reaction : Negative. 

Cas3 45 : White woman about 50 years of age. Advanced case of anesthetic 
type. Duration of the disease, unknown. Reaction : Negative. 

Case 46 : White woman, aged about 50 years. Incipient maculo-anesthetic 
case. Duration unknown. Reaction : Negative. 

Case 47: White woman, aged 87 years. Incipient case of maculo-anesthetic 
type. Duration, five years. Reaction : Negative. 

* Case 48 : Colored woman, aged 53 years. Advanced anesthetic case. Dura- 
tion, 27 years. Disease checked. Reaction : Negative. 

Case 49 : Colored woman, aged about 60 years. Advanced anesthetic case, 
the disease being stationary. Duration, 15 years. Reaction : Negative. 

Case 50 : White woman, aged 34 years. Maculo-anesthetic case. Former 
tubercles have disappeared. Duration, eight years. Reaction : Negative. 

Case 51 : White boy, aged 19 years. Advanced case of anesthetic type. Dura- 
tion, nine years. Reaction : Negative. 

Case 52: White man, aged 40 years. Maculo-anesthetic type, improving. 
Duration, 14 years. Reaction :' Negative. 

Case 53 s : White girl, aged 12 years. Incipient case of maculo-anesthetic type. 
Duration, four years. Reaction : Negative. 

Case 54 : Colored boy, aged 9 years. Incipient case of maculo-anesthetic 
type. Duration, four years. Reaction : Negative. 

Case 55 : White man, aged 43 years. Advanced case of anesthetic type. 
Duration, 30 years. Disease arrested. Reaction : Negative. 



44 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Case 56: White man, aged 54 years. Incipient case of anesthetic type. 
Duration, 10 years. Reaction : Negative. 

Case 57: White man, aged 58 years. Terminal case of anesthetic type. 
Duration, 30 years. Reaction : Negative. 

Case 58: White man, aged 56 years. Terminal stage of anesthetic type. 
Duration, 30 years. Reaction: Negative. 

Case 59: Chinaman, aged 75 years. Anesthetic case of 13 years' duration. 
Reaction: Negative. 

Case 60: White man, aged 46 years. Advanced anesthetic case. Patient 
claims to have been discharged cured from a Norwegian hospital 20 years ago. 
Duration, 25 years. Reaction : Negative. 

CONCLUSIONS. 

1. A positive Wassermann reaction is frequently obtained in cases of leprosy, 
giving no history or symptoms whatever of syphilis. 

2. The reaction is at times very strong, inhibition of hemolysis being complete. 

3. The reaction occurs chiefly in the tubercular and mixed forms of the 
disease, especially in advanced and active cases. 

4. In the cases of the maculo-anesthetic and purely trophic type the reaction 
is generally negative. 

5. The value of the test is not affected in the slightest by the results found 
in leprosy. 

In closing, I desire to express my thanks to Dr. Isadore Dyer for kindly 
putting at my disposal the splendid material of the Louisiana Leper Home. I 
also wish to thank Dr. Ralph Hopkins, the attending physician to the Leper 
Home for aid in obtaining case histories. For the material in New York I am 
indebted to the physicians whose names have been mentioned in the text. 



Symptomatology of Leprosy. 
[By Howard Fox, M. D., of New York.] 

As the number of lepers in New York City appears to be slowly but steadily 
increasing, it would seem that a knowledge of the symptoms of the disease is 
becoming of practical as well as of theoretical interest to the profession of 
this city. 

In briefly presenting the numerous and varied symptoms of leprosy it is most 
convenient to describe the two distinct and classical types of the disease, namely, 
tubercular leprosy, in which the skin and mucous membranes are chiefly affected, 
and anaesthetic leprosy, in which the nervous system is principally involved. 
Macular leprosy is described by some writers as a third type of the disease, 
and in a few cases the macules constitute practically the only symptom. In 
most cases, however, they are simply forerunners of either the tubercular or 
anaesthetic stages and need not be discussed as a separate type of the disease. 
In a large number of the cases there is a combination of symptoms constituting 
what is called the mixed type of leprosy. Practically all of the cases seen in 
New York are of the tubercular or mixed type, the cases of pure nerve leprosy 
being extremely rare. Indeed, among 30 cases which I have seen in New York 
City during the past year I can recall having seen but one case of pure 
anaesthetic leprosy presenting well marked deformities or mutilations. 

The symptoms of leprosy do not evolve with as much regularity as they do 
in syphilis for instance, and an artificial description of the stages of the disease 
seems hardly warranted. We do not know in what manner the infection occurs, 
as there is no primary lesion in leprosy that is comparable to the chancre of 
syphilis. It is therefore difficult or impossible to judge of the exact time when a 
certain patient has become infected. This may be estimated in certain cases 
in which, for instance, a person has resided for a short time in a leprous country 
and then returned to a nonleprous region and later presented the symptoms of 
leprosy. 

The period elapsing between the time of infection and the first manifestations 
of the disease the so-called period of incubation, has no parallel as regards 
length of time with any other infectious disease. Thus it may vary from 3 
months to 10, 20, or even 32 years, as in the case reported by Hallopeau. 



S. Doc. 306,64-1. 




CASE OF MACULAR LEPROSY IN A CAUCASIAN, SHOWING UNUSUAL CIRCINATE 
PATCHES. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 45 

The question as to whether the period of incubation represents a true germina- 
tion of the bacilli, or only a long period of latency or hibernation, is one that 
need not be discussed at this point. 

The general invasion of the body by the bacilli or their poisonous products 
may be marked by a group of symptoms or prodromata that are not in them- 
selves in any way diagnostic of leprosy. They include a rise of temperature, 
which may be mild and gradual, or sudden and severe, as in pneumonia. The 
fever may be accompanied by general malaise, headache, vertigo, drowsiness, 
severe sweating, and various rheumatoid pains. The patient himself is apt to 
ascribe such symptoms to a " bad cold " or an attack of malaria. These symp- 
toms may be followed in a few days by characteristic signs of leprosy, or the 
latter may not appear for many months, or even a year or more. It is, there- 
fore, not remarkable that after a considerable lapse of time these early 
symptoms should have been entirely forgotten, especially by the more ignorant 
class of patients. As a matter of fact, there are numerous cases, especially of 
the anaesthetic type, in which the prodromal symptoms are entirely lacking. 

A very early symptom which is observed in many cases, especially of the 
tubercular type, is a persistent rhinitis, with repeated mild attacks of epistaxis. 
This is thought by some to be as valuable a diagnostic sign as the haemoptysis 
of early pulmonary tuberculosis. If, in addition, the bacilli can be demon- 
strated in the nasal secretion an early positive diagnosis can of course be made. 

The onset of leprosy may be characterized by various sensory, vasomotor, 
and trophic disturbances that may or may not be associated with the pro- 
dromal symptoms. They include intermittent neuralgias of the legs, pruritus, 
hyperesthesia, profuse sweating, the symptoms of Raynaud's disease, etc. In 
a few cases a single isolated spot, comparable to an initial lesion, has been ob- 
served to have been the only symptoms of lepra for several years. In the great 
majority of cases the diagnosis of leprosy is not made or indeed the attention 
even directed to this disease until the appearance of the eruptive stage. This 
may occur within a few days, or perhaps years after the prodromata, or it may 
appear without any previous signs whatever. 

The first eruption of leprosy may consist of congested erythematous patches 
that could hardly be considered as characteristic of the disease. On a recent 
visit to Cuba (where I had the opportunity of seeing 170 lepers), I saw a 
patient in the San Lazaro Hospital with an erythematous eruption that looked 
strikingly like an erythema multiforme. It certainly would never have sug- 
gested the diagnosis of leprosy to my mind. After a number of days or weeks 
the early erythematous eruption disappears and may reappear later, accom- 
panied by fever and other general symptoms. After several repeated attacks 
in such a case the macules become permanent or " fixed," their color deepens 
and does not tend to disappear on pressure. In many cases, especially of the 
anaesthetic type, the macules make their appearance insidiously, without any 
constitutional symptoms, and are fixed and pigmented from the outset. In the 
majority of the cases, certainly as we see them in New York, the macules have 
become permanent by the time medical aid is sought. 

The macules vary in size from a pea to that of the palm of the hand, or may 
occupy large areas of the body, especially in the anesthetic type. Their borders 
may be sharply or poorly defined. They may clear up in the center and form 
circinate lesions, or gyrate figures from a coalescence of several such rings. 
The serpiginous tendency is chiefly noted on the lower extremities. The centers 
of the macules may present a loss of pigmentation, while their borders are 
superpigmented, and sometimes upon the leprous patch a vitiligo develops in 
the shape of white and depressed disks.- The macules may be hyperesthetic 
or itchy at the outset. Sooner or later they become anesthetic, the anesthesia 
being most marked in the center of the patches,- while the superpigmented 
border is often, for a time at least, hyperesthetic. The macules are roughly 
symmetrical, the symmetry being more marked in the anesthetic type. The 
sites of predilection are the face, extensor aspects of the extremities, the 
buttocks, and the back. The lesions are very rare upon the palms and soles 
and are almost never seen upon the scalp. There is generally noticeable ab- 
sence of sweating over the macules, and after considerable time there may be 
slight branny desquamation. While the macules may exist unchanged for 
many years they are usually followed sooner or later by the symptoms of 
tubercular or anesthetic leprosy, or a combination of both types. 

The first appearance of tubercles and,. indeed, the various crops of tubercles 
are often ushered in by febrile symptoms. In some cases they appear in- 

33993°— S. Rept. 306, 64-1 4 



46 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

sidiously without such general manifestations. They may appear in the form 
of diffuse flat infiltrations or as circumscribed nodules, varying from a small 
pea to a cherry or pigeon's egg in size. They are generally situated within the 
skin, although at times they may be beneath the skin, as in the shotlike nodules 
that may occur in the lobule of the ear. The tubercles may be engrafted upon 
or appear between the already existing macules. Their color varies from a 
light red, violaceous, or yellowish hue to a dark brown or reddish brown color. 
The surface of the tubercles is generally greasy from an excessive sebaceous 
secretion; it may be hyperesthetic or moderately anesthetic, and shows as a 
rule an absence of hairs. Indeed the falling of the eyebrows due to tubercular 
infiltration constitutes one of the earliest symptoms of nodular leprosy. The 
tubercles are found in the greatest number upon the face and the extensor 
aspect of the extremities. Upon the face they are chiefly noted upou the fore- 
head, nose, chin, and ears, and their presence imparts a peculiar frowuing or 
leonine expression to this form of the disease, which when once seen, can never 
be forgotten. For some unknown reason The scalp seems to enjoy a remarkable 
immunity to the ravages of leprosy, as it is never invaded by tubercles, and 
only in the rarest instances by macules. The palms and the soles are also very 
rarely the seat of tubercular infiltration. The tubercles are abundant upon the 
backs of the hands, elbows, knees, and about the ankles. As the last phalanx 
of the hand is spared for a time the infiltration of the first two phalanges gives 
the fingers a peculiar fusiform appearance. Upon the feet and ankles it is im- 
possible to distinguish individual nodules, as the skin of this region is often the 
seat of a diffuse, hard edema, presenting the picture of true elephantiasis. 
The nails, especially of the fingers, are often spared for a considerable time. 

During the exacerbations of leprosy which arc of frequent occurrence it is 
often noticed that the tubercles become reddened, swollen, and tender. At 
the end of these attacks some of the lesions are found to have decreased in 
size while new tubercles will have formed in other localities. The usual evolu- 
tion of the tubercles is to slowly disappear by absorption leaving a deep stain 
or a slight cicatrix or to soften and ulcerate. In a few cases they undergo a 
fibrous transformation. Ulceration of the nodules occurs more frequently in 
tropical countries and among the more ignorant and uncleanly class of patients. 
The ulcerations cover large areas at times and encircle an entire limb. They 
eventually heal and leave apigmented scars that may be somewhat anesthetic 
and are generally surrounded by a superpigmented border. 

The pharynx, palate, uvula, epiglottis, dorsum of the tongue and less often 
the mucous membrane of the mouth are sooner or later attacked by diffuse 
nodular infiltrations. These may persist for a time or become absorbed, ulcer- 
ate, or cicatrize. As a result of ulceration there is frequently distortion of the 
epiglottis or uvula. Perforation of the palate is very unusual. Later the in- 
terior of the larynx and even the trachea may be invaded by the leprous de- 
posits. A peculiar pallor is shown by the mucous membrane of the larynx and 
pharynx. One of the earliest symptoms of leprosy is a change in the voice, 
which may at first be slightly hoarse and later becomes harsh, sibilant, or 
whispering, and often interrupted by attacks of dyspnea. 

The visual apparatus is frequently involved in tubercular leprosy. The 
lesions involve the anterior segment of the globe, especially the sclerocorneal 
junction and the ciliary region. There may be a keratitis which gradually 
invades the entire cornea, or a tubercle may form at the limbus and penetrate 
into the anterior chamber and destroy vision. Iritis is also common and is 
most frequently of plastic type. 

The inguinal glands and less often the axillary and cervical glands are en- 
larged in tubercular leprosy and increase in size during the exacerbations of 
the disease. They are not as firm as the glands of syphilis and do not sup- 
purate in the latest stages of the disease. 

The urine often contains albumin and casts but no lepra bacilli, the changes 
in the kidney being due to an ordinary nonleprous nephritis. While the bacilli 
are as a rule disseminated in the internal organs, especially the liver, spleen, 
and bone marrow, they do not produce any characteristic symptoms except hI 
times an enlargement of the spleen or possibly of the liver. A double epi- 
didymoorchitis is fairly common and presents a compact mass with smooth or 
nodular surface, with or without any accompanying hydrocele. In the rate 
cases in which fistula? form, there is probably a secondary infection from the 
tubercle bacillus. In the majority of cases the disease causes a diminution of 
sexual power and desire. In women the menses become irregular and finally 
cease. In the case of young girls this function is not established at all. 



S. Doc. 306, 64-1 . 




NODULAR LEPROSY OF THREE YEARS' DURATION IN A CAUCASIAN. 



TREATMENT OE PERSONS AFFLICTED WITH LEPROSY. 47 

Among other symptoms of tubercular leprosy should be mentioned a general 
darkening of the skin, a dusky cyanosis of the fingers, the appearance of 
occasional flaccid bulla?, and enlargement of the ulnar nerve. 

The course of tubercular leprosy is in most cases chronic, the average dura- 
tion of life being about from 8 to 10 years. The most favorable termina- 
tion of the form of the disease is a change to the anesthetic type in which 
case the symptoms ameliorate and the patient's life is often considerably pro- 
longed. The tubercular leper in the terminal stages of his affliction is indeed an 
object of pity. The face is distorted by a mass of tubercles, many of them are 
covered with crusts and ulcers. There is a foul discharge from the nose and 
general foetid odor from the lungs and skin. The voice is lost, sight is destroyed, 
and of the special senses hearing alone remains. The patient is extremely 
cachectic and weak and suffers from continual diarrhea, and is robbed of his 
sleep by intense neuralgic pains. In spite of such a terrible condition the mind 
of the leper remains practically unaffected up to the time of his death, which 
is generally due to marasmus, diarrhea, stenosis of the larynx, or an inter- 
current disease or complication such as pneumonia or pulmonary tuberculosis. 

The onset of anesthetic leprosy may be accompanied by febrile symptoms as 
in the tubercular type. It is, however, more apt to appear insidiously and make 
itself manifest by a macular or bullous eruption or by various disturbances of 
sensation. The macules, according to Impey, are not due to the presence of 
bacilli in the skin but to vasomotor action on the terminal branches of the 
cutaneous nerves. The same is probably true of the bullous eruption in which 
the lesions are as a rule free from lepra bacilli. " While the cutaneous eruption 
in nerve leprosy," writes Morrow, " is not so essentially a part of the morbid 
process as in tubercular leprosy, the macules exhibit a greater variety of aspect, 
especially in their configuration and coloring." They are more apt to persist 
and to clear up in the center and form vitiligoid patches, especially in the dark- 
skinned races. The hairs upon the macules do not fall, but are more apt to 
become white. 

The bullous eruption is more often encountered in the early stage of the dis- 
ease, the lesions varying in size from a split pea to a cherry. They may appear 
upon any part of the body except the scalp, but are seen upon the hands, elbows, 
knees, ankles, and also the palms and soles. The bullae soon rupture, dry, and 
form crusts followed by cicatrices. 

The symptoms in general of the anesthetic type are those of a peripheral 
neuritis, causing various sensory and trophic manifestations. In contrast with 
the tubercular type of the disease, which is characterized, as von Bergmann 
says, by marked hyperplasia, the noticeable changes in anesthetic leprosy are 
those of atrophy. 

One of the most important and diagnostic symptoms is an increase in the size 
of some of the nerve trunks that occurs at a very early period of the disease. 
The greatest changes are observed in the nerves that are superficially situated, 
such as the ulnar and median nerves. They are changed to cylindrical or fusi- 
form or beaded cords, and may at times attain the thickness of the little finger. 
The ulnar enlargement is especially characteristic and may at times be felt in 
its entire course from the elbow to the axilla. At the outset the nerve trunks 
are painful upon pressure, but later become completely insensible to pain. 

The disturbances of sensation in leprosy may be confined to the macules or 
exist independently of them. The characteristic anesthesia, which represents a 
complete disorganization of a nerve trunk, is invariably preceded by irritative 
symptoms. There is often hyperesthesia, which may be intense, or there may 
be pruritiis, neuralgic, or shooting pains, or various forms of paresthesia. 
There may be vasomotor symptoms, such as cyanosis, or secretory disturbances, 
such as interference with sweat secretion. 

Sooner or later anesthesia makes its appearance, and is especially marked in 
the extremities. It is first noticed in the fingers and toes and then travels 
upward toward the trunk. It is often bandlike at first, but later involves the 
entire circumference of a limb. Part of the area of anesthesia is fixed, while 
the rest, according to Jeanselme, varies in intensity from clay to day. There 
is often dissociation of sensation, that of temperature and pain disappearing, 
for instance, while the sensation of touch remains. Sensation may also be 
delayed, as when the prick of a pin is felt after an interval of several seconds. 
The anesthesia becomes complete at last, so that the patient may be able to 
cut off portions of" the hands or feet without experiencing the slightest pain. 

L Muscular atrophy is one of the constant and striking symptoms of anesthetic 
Leprosy. There is a diminution in force in proportion to the waste of muscle 



48 TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 

tissue. At times there is a true paralysis. Atrophy is noted at an early stage 
in the thenar and hypothenar regions. From atrophy of the first dorsal in- 
terosseous a characteristic hollowing of the back of the hand is produced. One 
of the commonest deformities is the "leper claw" produced by tendinous 
retractions and muscular atrophy. Ii is formed by extension of the first and 
a flexion of the second and third phalanges. The palm is flattened and the 
thumb is on the same plane with the fingers. In spite of this deformity the 
use of the hands is far from being lost, especially if the sensation of touch 
remains. 

The superficial muscles of the face are frequently atrophied and can give 
the patient an appearance that is as characteristic as the leonine face of the 
tubercular leper. The eyes have a peculiar stare and the lids can not be closed. 
The lips are flaccid and pronunciation of labials is difficult. On account of 
eversion of the lower lip saliva may flow from the mouth. The face becomes 
an expressionless mask, and the patient's appearance is stupid and doleful. 

In some cases the process of anesthetic leprosy does not go beyond the pro- 
duction of muscular atrophy and tendinous retraction. In other cases, where 
the disturbance of nutrition is very great, there are bone changes which give 
rise to frightful mutilations. The loss of bone may occur from necrosis or from 
a process of interstitial absorption. In the case of the fingers the second 
phalanx is apt to be the first to disappear, so that the fingers appear to have 
only two phalanges. In some cases the nails are preserved with remarkable 
tenacity in spite of extensive loss of bone. Finally, the hands and feet become 
veritable stumps, the shape of the feet being compared to that of a pestle or 
drumstick. Large trophic ulcers, among them the so-called perforating ulcers, 
may add to the patient's distress. 

The mucous membranes are much less often involved in the anesthetic than 
in the tubercular type of leprosy. As the lower lid is everted the conjunctiva 
is unprotected and soon becomes inflamed. Corneal opacities may form and 
destroy the sight. Ulceration and destruction of the septum, with consequent 
sinking of the nose, is not uncommon. Due to loss of tactile sensation, there 
is often difficulty in swallowing, the food being regurgitated into the nostrils. 

The course of anesthetic leprosy is decidedly chronic, the average duration 
of life being about 15 years. In some cases the process appears to come to a 
standstill and the patient is apparently cured. A number of such cases have 
been reported by Dyer, of New Orleans. In a few cases the anesthetic type 
changes to the tubercular form of the disease. 

The termination of a severe case of anesthetic leprosy presents a totally 
different picture from that of the tubercular type, but one that may be equally 
pitiful and distressing. The anesthetic leper is emaciated and cachectic. He 
is bedridden and has to be fed by attendants. The nose is sunken, the sight is 
extinguished, and saliva pours from the paralyzed lips. The patient suffers 
from a sense of cold, loss of appetite, insatiable thirst, and severe neuralgic 
pains. The numerous ulcerations add to the natural disagreeable odor of the 
leper and the deformities of the limbs make them scarcely recognizable as 
those of a human being. The patient's mind is dull, but by no means lost. 
Death is generally due to marasmus, amyloid degeneration of the viscera, 
diarrhea, or to an intercurrent disease. It is rarely due to pulmonary tubercu- 
losis. 

The Chairman. We are very much obliged to you, Doctor. The 
committee will next hear Dr. Bracken, of Minnesota. 

STATEMENT OF DR. HENRY M. BRACKEN, SECRETARY OF THE 
STATE BOARD OF HEALTH OF MINNESOTA. 

The Chairman. Doctor, just proceed in your own way, giving your 
ideas about this bill. 

Dr. Bracken. To begin with, Mr. Chairman, I wish to state that 
I am most heartily in favor of the bill, and that the various State 
health officers have been arguing for such a bill for years. I know 
that efforts have been made to secure a national leprosarium since 
1898. The Conference of State and Provincial Boards of Health 
has had this subject before it for years, and has at various times 



S. Doc. 306, 64-1 




ANAESTHETIC LEPROSY IN A CAUCASIAN SHOWING "CLAW HAND' 
AND ULCERATION. 



TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 49 

passed resolutions urging that such an institution or institutions be 
provided. The subject has also come up from time to time at the 
Conferences of State and Territorial Health Officers, which the 
Surgeon General of the United States Public Health Service is 
required by law to call yearly. 

The Chairman. Why do we need it ? 

Dr. Bracken. Because this is a problem that the States can not 
solve. In many of the States the lepers found do not belong to the 
State. For example, Dr. G. A. Hanson, of Bergen, Norway, reported 
in 1888 that about 160 lepers had migrated into three States — Wis- 
consin, Iowa, and Minnesota. At the time that he wrote probably not 
more than 20 of these 160 lepers were still alive. Dr. Hanson further 
states : " The number of immigrated lepers from Norway is much 
greater than I had any idea of from the knowledge we could gather 
at home. My friends have given me the names of many lepers here 
in America whom we did not know to be lepers when they left Nor- 
way." It is true that the United States quarantine regulations ex- 
clude known lepers, but leprosy may lie dormant for a considerable 
length of time. Hence people may enter the United States and live 
here a considerable time before discoverable symptoms of leprosy 
appear. The Federal quarantine regulations can not prevent such 
lepers entering the country. 

A record of lepers has been kept in Minnesota since 1888, and the 
record for the total 83 is as follows : 

Disease present at time of entry 32 

Symptoms appearing 1 year after entry 2 

Symptoms appearing 2 years after entry 2 

Symptoms appearing 3 years after entry 4 

Symptoms appearing 4 years after entry 3 

Symptoms appearing 5 years after entry 1 

Symptoms appearing 6 years after entry 1 

Symptoms appearing 7 years after entry 3 

Symptoms appearing 8 years after entry 4 

Symptoms appearing 9 years after entry 3 

Symptoms appearing 10 years after entry 2 

Symptoms appearing 11 years after entry 1 

Symptoms appearing 12 years after entry 

Symptoms appearing 13 years after entry 3 

Symptoms appearing over 13 years after entry . 8 

Not stated 8 

Born in United States 6 

It would appear, therefore, that of the 73 lepers coming into Min- 
nesota from foreign countries (for they were all foreigners), 41 of 
them developed symptoms after they came to America. It is true 
that the symptoms may have been present in possibly 11 of these at 
the time of entry, but if so they were unnoticeable (at least so re- 
ported) by the lepers or their friends and unrecognized by the port 
quarantine inspectors. 

There are now living in Minnesota eight known lepers. Three of 
these were born in Minnesota, hence State cases, but born of foreign 
parents; hence they received their infection from foreign sources. 

Leprosy is not easily recognized; first, because the leper may not 
come under medical observation until the disease is well advanced, 
and it is therefore a mere accident if the case is discovered ; and, sec- 
ond, because the physicians in general see so few cases of leprosy 



50 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

that when it appears they are very apt to class it as some other dis- 
ease until it is so far advanced that it is easily recognized. 

Still further, those afflicted with leprosy seldom recover. The dis- 
ease being, therefore, one that remains with the individual for the 
rest of life, becoming gradually worse and worse, the individual 
becomes an outcast in many instances and wanders from State to 
State. 

It is impossible for any one State to take charge of and keep these 
wandering lepers. All of the arguments point to the necessity of 
Federal care for the leper, but there is still another point. Few 
States have a sufficient number of lepers to justify the construction 
of a proper building where such patients can be cared for in a humane 
way and given such treatment as may possibly result in recovery. 
It is a well-recognized fact that a certain percentage of lepers will 
recover if they are properly cared for. Such treatment is not given 
to the lepers in the United States, for, as far as I know, but two 
States have made any provision for the proper care of their lepers, 
namely, Louisiana and Massachusetts. 

Senator Works. Have you any provision in Minnesota for taking 
care of lepers? 

Dr. Bracken. No. The health unit in Minnesota is the township. 
It is impossible for any township properly to care for a leper found 
resident in such district, and, further, it is impossible for the town- 
ship to transfer the responsibility for the proper housing and care 
of such an individual to the State. The county may aid in the 
proper control of the case, but this is not a satisfactory means of 
caring for the leper. 

The Chairman. What is the method of taking care of a leper when 
found ? 

Dr. Bracken. When a leper is found, the health authorities of the 
district in which the leper lives are notified. The leper is isolated at 
home if possible. If the leper has a home he or she is isolated 
in the home. If the leper is a pauper the question then becomes 
exceedingly difficult to handle. If the leper is isolated at home the 
leper, the members of the family, and the local health authorities are 
notified as to what shall be clone in order to prevent the spread of 
infection to others. In some instances the leper leads a quiet home 
life without annoyance. In others life is made unendurable not 
only for the leper but for the entire family, for in many instances 
the entire family is ostracized. 

Senator Works. How many lepers have you in your State? 

Dr. Bracken. So far as I know, there are eight living lepers. 

Senator Works. Is this division of responsibility in health matters 
in your State made so by law, or by the rules and regulations of your 
State board of health ? 

Dr. Bracken. By the State law. The State board of health is 
given advisory jurisdiction but we have no authority over these indi- 
vidual cases. We can only advise the local health authorities what 
to do. 

Senator Smoot. I suppose it is the same as in my State. The dis- 
ease develops and the city authorities take charge of it, if they can 
handle it ; but if the burden is too big the city has a right to ask the 
county in which the city is located to take charge of the case. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 51 

Dr. Bracken. In Minnesota that depends partly on the method of 
caring for paupers. If this is on the county plan, then the actual 
housing, feeding, and clothing of the leper may be transferred to the 
county. But in many sections of our State paupers are cared for on 
the township plan, and then the burden of caring for the individual, 
both as a pauper and a leper, rests upon the township with the pos- 
sibility of recovering part of the expense from the county. 

As an illustration of this feature in Minnesota, at present we have 
a poor woman, a leper, the mother of several children, and having a 
shiftless husband. These people live as paupers. The father of this 
woman, a Norwegian, died in Minnesota some years ago. Later a 
brother died. The father and brother both lived and died in the 
same house. This woman, when she was found to be a leper, lived 
in a township adjoining that in which her father and brother had 
lived. Naturally she should have been returned to the old home, but 
the township officials of the township in which this home was located 
objected to her being returned. Therefore she continues to live in a 
township in which she does not really belong, but where they are 
practically living as squatters in an abandoned old farmhouse, sup- 
ported in part by the township and in part by the county. 

The Chairman. Is this woman who is still living in your State 
under confinement? 

Dr. Bracken. No ; there is no danger of her infecting any outside 
of her own family; but while she is given advice as to how she 
should live to prevent the infection of her children, it is almost 
impossible for her so to live. She, of course, can not leave the 
home, but her children have not been separated from her. 

The Chairman. Do you regard this as very dangerous — for the 
children to be living with her? 

Dr. Bracken. I certainly do. 

Senator Smoot. Do you have a provision for handling smallpox 
cases ? 

Dr. Bracken. Certainly. We can control those ill with smallpox ; 
but, as you know, these patients quickly recover, and this is a com- 
paratively easy matter. We can not make proper provision for 
caring for the few lepers in our State during the remainder of their 
lives. The possibility of segregating this woman in the township 
where she lives for the rest of her life does not exist under present 
conditions. 

Senator Works. It looks as if you were asking the Government 
to do what your State ought to do. 

Dr. Bracken. Hardly. If foreign lepers had been shut out of the 
United States, Minnesota would never have had any lepers to take 
care of, for all of the American-born lepers which we have had in 
Minnesota have received their infection from foreign lepers which 
came into this country. 

The Chairman. How does the profession generally in your State 
feel toward the enactment of such a measure as this, Doctor? 

Dr. Bracken. The profession there is strongly in favor of such an 
institution. 

The Chairman. Do you know of any opposition? 

Dr. Bracken. None whatever. 



52 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Senator Smoot. Many of the people in your State don't know 
anything about it, do they? 

Dr. Bracken. Yes; many of them are familiar with conditions. 

Senator Smoot. The matter has not been very public. 

Dr. Bracken. No. 

Senator Works. You are not able to find any objection on the 
part of the people of your State to having the National Govern- 
ment take care of these people whom the State itself ought to handle? 

Dr. Bracken. That is not the point. 

Senator Works. That is one point. 

Dr. Bracken. The real question is with regard to giving the pa- 
tient proper relief. 

Senator Smoot. In the case of leprosy, when death comes it is a 
relief. 

The Chairman. Leprosy is also a menace to the public health 
when a case breaks out? 

Dr. Bracken. Yes. 

The Chairman. Is it generally considered by your profession that 
such a bill as this would be desirable ? 

Dp. Bracken. It is. 

The Chairman. Are there any further questions? If not, we will 
excuse Dr. Bracken. We are very much obliged to you, Doctor. 

We will next hear from Dr. Parker, of Massachusetts. 

STATEMENT OF DR. FRANK H. PARKER, SUPERINTENDENT OF 
THE STATE LEPER COLONY OF MASSACHUSETTS. 

The Chairman. State what position you occupy, Doctor. 

Dr. Parker. Superintendent of the State leper colony of Massa- 
chusetts. 

Senator Beckham. I judge from the title of the institution that 
the lepers there work. 

Dr. Parker. Only what they wish to do. There is no compulsion 
whatever. Some have their gardens, and we encourage them all, if 
able, to do something. We pay two of the Chinese patients for do- 
ing the laundry work for the other patients. 

The Chairman. Will you describe your colony and your method 
of work and give your idea of the necessity of a bill of this kind? 
Tell us how many patients you have, and so on. 

Dr. Parker. Commencing with our leper history in Massachusetts, 
we have no authentic record of any lepers previous to 1882. Since 
then we have had 30 cases, representing 11 different nationalities, 
namely, 4 Chinese, 1 Japanese, 1 Swede, 3 British West Indians, 6 
Cape de Verde Islanders, 2 Russian (Lettieh), 4 Russians (He- 
brews), 2 Greeks, 1 Italian, 1 Syrian, 4 Americans, and 1 unknown. 
There were 23 males, 6 females, and 1 unknown; 15 were single, 9 
married, 1 widow, and 1 widower. In 4 the civil status was un- 
known. Nine were known to have children with whom they had 
been living since the onset of the disease. Three were mariners or in 
some form followers of the sea, 6 were outdoor laborers, 3 laundry- 
men, 2 cooks, 1 painter, 1 brush maker, 1 factory hand, 2 clerks, 1 
dishwasher, 3 housewives, 2 domestics, 1 student, and 1 teacher. The 
occupation of 3 was not ascertained. 



S. Doc. 306, 64-1, 




ADMINISTRATION BUILDING, MASSACHUSETTS LEPER COLONY. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 53 

In 3 of these cases the disease took the anaesthetic form, in 2 
the type would be most accurately defined as " mixed," and 23 cases 
exhibited the tubercular form ; in 2 of the early cases the record fails 
to show the form of the disease. With the exception of one case, 
the history of which is unknown, these patients were either im- 
migrants or showed a history of travel and sojourn in foreign coun- 
tries or districts where leprosy is more or less prevalent. 

Senator Smoot. How many have you to-day ? 

Dr. Parker. We have 11 at the present time. Previous to the 
establishment of our leper colony, which took place in 1905, the lepers 
were sent to Gallops Island in Boston Harbor, a quarantine station. 
There they usually rounded out their existence, although we have a 
record of one or two who escaped. In 1905, by the enactment of State 
law, money was appropriated for the establishment of a leper colonj^ 
We had some little trouble in locating such an institution. At first 
it was thought preferable to have it on the mainland. The State pur- 
chased a farm with that idea in view. There was swch a tremendous 
wail went forth that possibly the largest hearing ever had upon so 
small a question — if this question can be called a small one — was held, 
protesting against the site which the State had purchased. So strong 
was the protest that the project had to be abandoned, so far as that 
location was concerned, the people agreeing to buy the property 
back from the State, paying dollar for dollar or more, if necessary > 
for all that had been expended there. Then we had to look further, 
and we went to sea. Finally we located the colony on Penikese 
Island in Buzzards Bay, where we acquired the property by right of 
eminent domain. The State paid for that site the sum of $25,000. 

Since that time considerably larger amounts have been expended 
upon it in the improvements, etc. 

Senator Smoot. How much have you spent altogether ? 

Dr. Parker. We have spent on leprosy in the State of Massachu- 
setts, since 1905, $265,000. 

Senator Smoot. What are your improvements worth ? 

Dr. Parker. We have spent from $75,000 to $85,000 in improve- 
ments. We built six cottages, each containing six rooms, including 
bathroom, hot and cold water, open plumbing, each intended for two 
occupants. Later two of these cottages were united, forming the hos- 
pital. This building contains two wards of five rooms each, billiard 
room, a large living room, a general dining room, large kitchen, five 
bathrooms, a private suite of four rooms for the nurses, and chambers 
for the matron, steward, and other help. An administration build- 
ing, an electric-light plant, a refrigeration and ice-making plant, a 
steam laundry, and many minor improvements. Two water systems, 
one fresh and one salt, supply all of the houses. 

While we do not make any boasts of having an elaborate plant, we 
do contend that we have a very comfortable one, with most of the 
modern improvements and conveniencies to make life pleasant for our 
patients and those who minister to them. 

Senator Smoot. In other words, you have spent about $200,000 for 
11 patients. 

Dr. Parker. This represents what we have spent on all of the 
patients since its institution — 24 in all. 



54 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Senator Smoot. This bill provides for $250,000 for taking care of 
all the lepers in the United States, which amount to something like 
1,000. Do you think it is possible to provide for the sum of $250,000 
sufficient accommodations to take care of 500 to 1,000 patients? 

Dr. Parker. Not at the ratio we have spent in Massachusetts for 
our 24 patients. 

The Chairman. You said you spent that much ? 

Dr. Parker. Since we began. 

The Chairman. That is the annual maintenance charge and sal- 
aries, etc., since you began? 

Dr. Parker. Yes, sir. 

Senator Smoot. What is your average annual maintenance charge ? 

Dr. Parker. Possibly about $15,000, although for the past two 
years it has been $28,000. 

Senator Smoot. In eight years that would take up all the money 
that has been spent. 

Dr. Parker. At the start our maintenance was very small, but 
each year we have added to our plant, and with the improvements 
has naturally come an added cost of maintenance. We have to em- 

J)loy help from the outside and we are obliged to pay somewhat 
arger salaries than in similar positions elsewhere. 

Senator Works. What is the highest number of patients you have 
had? 

Dr. Parker. Eighteen at one time; several have died and three 
have been deported. We have had 24 in all. 

Senator Works. It costs the State $2,700 for each patient ? 

Dr. Parker. Nearer $2,500, or about $49 a week. 

The Chairman. Since you began? 

Dr. Parker. No, sir ; that is what it is costing at the present time. 
With our added improvements our expenses increase, and our over- 
head expenses and care of the island are about as heavy as though we 
had 50 or more patients. 

Senator Smoot. Not since you began ? 

Dr. Parker. It was much less than that in the beginning. We com- 
menced quite unassumingly and have gradually developed our present 
plant. 

Senator Smoot. The annual appropriation for the colonv is about 
$28,000? 

Dr. Parker. That is what it has been the last two or three vears. 

Senator Smoot. That would be $2,600 to $2,700 per patient at the 
present time ? 

Dr. Parker. Yes; about that at the present time. 

Senator Smoot. Per annum ? 

Dr. Parker. Yes, sir. 

Senator Beckham. Have any cures been effected ? 

Dr. Parker. We can hardly claim positive cures, yet two have 
been so far relieved that their release was recommended, as they were 
no longer in a condition to be a menace to the public health. 

One, a Chinaman, availed himself of the privilege and returned to 
China, the other has not as yet left Penikese. 

In one case, through the influence of friends and by the enactment 
of a State law which provides for the discharge of patients under 
certain conditions, the patient was removed, to be cared for by friends 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 55 

in New York State. This was done with the consent of the authori- 
ties of that State. 

Senator Smoot. Were these two who were discharged actually 
cured, or were there still the elements of leprosy in their system? 

Dr. Parker. We could find no positive evidences of any presence 
of the disease in the system by microscopic examinations, which we 
thought quite thorough. We would not want to say there was not 
some nidus of infection that might make itself manifest at some 
future time. 

The Chairman. Can you tell positively by tests whether a man has 
leprosy or not? 

Dr. Parker. If we can find the presence of the lepra bacilli, we 
have positive proof of it. 

The Chairman. If you do not find the lepra bacilli, do you say he 
is cured? 

Dr. Parker. A person once having had the disease, I would not 
want to say positively until a number of years had passed without 
any recurrence of symptoms, and they had proven themselves micro- 
scopically negative. We have never sent any cases to Penikese Island 
without first finding the lepra bacillus. We maintain there quite a 
complete research laboratory to help us in our experience. 

The Chairman. Have you been using chaulmoogra oil or have you 
had other remedies? 

Dr. Parker. We have used that from the beginning. We have 
used everything that is on record as giving relief, and in most every 
way. Not every patient can assimilate the large doses of the oil that 
are required to produce the desired effect. It becomes repulsive to 
them and they often refuse to take it. We are at the present time 
using Dr. Heiser's method of administering the oil, although we have 
not carried it far enough or long enough as yet to see much result. 
But we anticipate good results in view of the good work Dr. Heiser 
has done. At one time we imported Leproline, an Indian remedy, 
but the result of its use did not warrant its continuance. 

The Chairman. Do your patients go to you voluntarily, or are they 
sent? 

Dr. Parker. The health authorities send them. It is compulsory 
by the State laws; yet many of them have come willingly. 

The Chairman. Are the doctors of the State required to notify 
the authorities whenever a case develops? 

Dr. Parker. Yes, sir. 

The Chairman. How does the profession of your State feel toward 
the enactment of some such law as that contemplated in the bill ? 

Dr. Parker. In regard to the profession in general, I do not know 
that I can answer intelligently, because they know we have a State 
hospital for such cases, but the taxpayers would like, of course, to 
have the Government assume the responsibility, although we would 
not want it done unless it was going to be for the betterment of our 
patients. 

The Chairman. How do you feel about such a law yourself? 

Dr. Parker. As for our own State, I feel we are doing fairly well 
as it is, but on the part of the people at large I should say they 
would like to change simply more on account of the expense. It is 
quite heavy for us for the few patients we have. At the same time 



56 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

I wish to go on record for the State of Massachusetts as being in 
favor of the bill if it means better care and more humane treatment. 

Senator Smoot. There are States where no provision is made, and 
other States where the facilities are altogether inadequate. The 
question is whether the Government should do for the States what 
the States ought to do themselves, as your State has done and as 
they have done in the State of Louisiana. 

Senator Beckham. If the people of Massachusetts can do as they 
have done at considerable expense and take good care of the lepers, 
are the people of Massachusetts thereby secure from the dangers of 
that disease from other States when such other States have not 
taken similar steps? 

Dr. Parker. Not as much as we ought to be, yet the State with 
no laws governing the situation or are lax in the enforcement of 
such as they may have suffer the most, as such States form tempting 
places of abode. These people naturally shun and avoid those places 
where the laws are stringent and enforced. 

From our standpoint all of the States should have laws govern- 
ing the situation or the National Government, whichever is deemed 
the wisest and best. One or the other condition should prevail, as 
the only possible way to handle the problem properly is by seg- 
regation. 

Senator Beckham. It would be necessary for every State uni- 
formly to deal with the question and take care of the cases in that 
State, would it not? 

Dr. Parker. There should be uniformity; yes, sir, to insure suc- 
cess. 

Senator Beckham. Is it likely or possible to have uniformity? 

Dr. Parker. Not at the present time with so many States in- 
different. 

Senator Works. Are there a good many States where the patients 
are not segregated at all? 

Dr. Parker. Yes, sir. 

Senator Weeks. How many States? 

Dr. Parker. Probably 24 or 25 ; possibly more. 

Senator Weeks. Have you taken them from any other States to 
care for in your institution? 

Dr. Parker. No, sir. 

Senator Weeks. Have you had any requests to do so? 

Dr. Parker. Yes, sir. 

Senator Weeks. Is there any hospital in New England to care for 
them? 

Dr. Parker. Only that in Massachusetts. 

Senator Weeks. What would be the objection to taking cases from 
other New England States? 

Dr. Parker. Under the State laws, we can not. The moment we 
take them over the border line into the State of Massachusetts they 
become a State charge, and we can not claim anything from the other 
State for maintenance. I suppose the only thing to do would be for 
the States interested to enter into a contract, and that would mean a 
contract made between the governments of the States interested, and 
n< t between the local authorities. 

Senator Weeks. Have other cases appeared in New England? 

Dr. Packer. Yes, sir. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 57 

Senator Weeks. What has been done with them ? 

Dr. Parker. They have been taken care of in those States where 
they occurred. 

Senator Weeks. Why can not a contract be made, such as you sug- 
gest? Do the laws prohibit such a contract? 

Dr. Parker. No, sir; the laws do not prohibit such a contract, so 
far as I know, but the parties interested have never gone that far. 

Senator Weeks. It would reduce your per capita expense if you 
had the privilege of taking in patients from other States, would it 
not? 

Dr. Parker. Surely. 

Senator Weeks. How large is this island ? 

Dr. Parker. In the neighborhood of 100 acres. 

Senator Weeks. How many patients could be accommodated there 
if you had buildings constructed on the space available? 

Dr. Parker. I imagine we could easily take care of 50 to 100 cases, 
with the proper facilities. The patients at the present time have 
the run of two-thirds of the island, and there must be plenty of room 
for them. 

Senator Weeks. What room do they need ? 

Dr. Parker. Simply for them to exercise and large enough to 
roam about somewhat; they do not like the thought that they are 
prisoners. They enjoy that freedom which a large space engenders. 

Senator Weeks. On 65 acres, I think you could accommodate a 
great deal more than 20. 

Dr. Parker. We can, but we have accommodations at present for 
only 20, or possibly a few more if it was urgent at short notice. 

The Chairman. Do you think the Commonwealth of Massachusetts 
will pass a law permitting you to take care of lepers from other 
States? 

Dr. Parker. It might, possibly, if the proposition was advan- 
tageously presented to the legislature. 

The Chairman. I heard that John Early had sought admission 
to your home. Is that a fact ? 

Dr. Parker. I can not say that he has applied directly; no. I 
have had some correspondence with Mr. Early, but never in the 
sense of his applying for admission to the institution. 

The Chairman. Perhaps I misunderstood. 

Senator Weeks. Concerning the danger of disease coming from 
other States, have you been able to determine if any of your patients 
have come from other States ? 

Dr. Parker. No, sir ; not directly ; the most of our patients are 
foreigners who landed in Massachusetts: Our little community is 
quite cosmopolitan. 

Senator Beckham. As long as these other States do not segregate 
their lepers there will be that danger, will there not ? 

Dr. Parker. Of course there is a certain amount of danger from 
that source. 

Senator Weeks. Do you see any objection in a bill of this kind, if 
it were passed and the Government established a hospital for lepers, 
to having the States pay their proportional cost of conducting the 
hospital, based on the number of patients sent there, and each State 
being compelled to send them to such hospital ? 



58 TREATMENT OF PEESONS AFFLICTED WITH LEPROSY. 

Dr. Parker. Possibly that would be outside of my province to 
answer. The State legislature would want to answer that question. 
Personally, it seems fair and equitable. 

Senator Weeks. Without reference to the question of objection to 
the location of such an institution, suppose the institution were estab- 
lished, do you think there would be anything in the way of requir- 
ing the State of New Hampshire, for instance, if a case developed 
there, to send that leper to the national institution and be required 
to pay its proportional share of the cost of maintaining the insti- 
tution? 

Dr. Parker. Possibly not. I do not see why each State should not 
pay for the care of its dependents wherever they are. 

Senator Weeks. I do not see Avhy they should not, either. 

Dr. Parker. In Massachusetts the law provides along that line. 
If a dependent person, for instance, is ill in Boston, where he is taken 
care of, and the person lives in Springfield and has an established 
settlement there, Springfield must pay for the care given him. This 
illustrates the same idea. I should think it would apply interstate as 
well as intrastate. 

Senator Weeks. It is the same principle. 

Dr. Parker. Yes, sir. 

The Chairman. Have you been able to work out to your own satis- 
faction how this disease is communicated? 

Dr. Parker. No, sir; we know it is due to a germ — the lepra 
bacillus — and if anybody could solve the method of conveyance it 
uould be a great boon to mankind. We would all be very grateful 
to him. 

The Chairman. Are there any further questions? If, not. Dr. 
Parker will be excused. 

Dr. Parker. Thank you. 

The Chairman. We are very- much obliged to you, Doctor. We 
will now hear from Dr. Engman, of Missouri. 

STATEMENT OF DR. MARTIN F. ENGMAN, PROFESSOR OF SKIN 
DISEASES IN WASHINGTON UNIVERSITY, ST. LOUIS, MO. 

The Chairman. What is your position — your official position? 

Dr. Engman. I am professor of skin diseases in Washington Uni- 
versity, in St. Louis, Mo., and president of the medical board of the 
Barnard Free Skin and Cancer Hospital, St. Louis. 

The Chairman. Have you made a special study of lepers and of 
leprosy ? 

Dr. Engman. Leprosy is one of the diseases included in my spe- 
cialty; therefore I may say I have made special study of it. I have 
seen lepers for the last 20 years in this country and in Europe, and 
have made some studies upon the disease with Prof. Unna, of Ham- 
burg, Germany. I can not say I have made a specialty of leprosy, 
but the mystery, the historical interest, and the social menace in the 
disease have particularly attracted my attention for a good many 
years. 

The Chairman. Are there several cases of leprosy in your State? 

Dr. Engman. Yes, sir; we have been seeing leprosy there for a 
good many years. I have been in St. Louis, occupied in the practice 



TREATMENT OP PERSONS APPLICTED WITH LEPROSY. 59 

of medicine, for 19 years, and have quite frequently encountered the 
disease. 

The Chairman. Can you give us some idea of about how many 
cases there have been? 

Dr. Engman. No, sir ; I could not. It would be impossible for me 
to tell you how many cases have occurred in St. Louis during that 
time. In my own personal experience in the last 15 years I have 
seen in public and private practice at least 15 lepers, and I have 
known of other cases of leprosy seen by my colleagues. 

The necessity of a national leprosarium appeals to me in a very 
dramatic way. In the summer of 1913 there appeared at my clinic 
at Washington University a young man, probably 35, American born, 
with a skin disease which had appeared a few weeks' previous to 
his visit. He was married, had two children, and his wife kept a 
rooming house on one of the thoroughfares of the city. This case be- 
came quite celebrated in a newspaper way. I was not in St. Louis at 
the time, but one of my colleagues upon examination of the man 
found him to be suffering with leprosy. The man's name was H. 
He was told of his condition, which, of course, was a frightful shock 
to him. Leprosy is a quarantinable disease in our State, therefore 
the board of health were immediately notified, and the patient was 
put under arrest. He was conveyed in an ambulance to a small house 
near the smallpox hospital on the outskirts of the city. The building 
was already occupied by a Chinese leper who had had the disease for 
a number of years and was horribly mutilated and hideous to behold. 
The poor Chinaman, however, warmly welcomed his companion in 
suffering, with the hideous leper smile, and held out his mutilated 
hands in token. A guard was placed at the entrance to the cottage, 
but as dusk approached H. escaped. He appeared at the residence of 
some relatives of his, who lived in a village across the river in Illinois, 
as he feared to visit his wife or children. 

In the meantime the evening papers made flaring headlines of the 
case and the relatives,, therefore, were informed of his pitiable con- 
dition and he was driven from their door and from the village. He 
ran like a maddened animal into the woods and was hounded from 
town to town. He finally took blind baggage and escaped into 
Mexico, where he remained for a few months. This man was an ex- 
soldier in the Philippines, where he, no doubt, had become infected 
with the disease. He had been honorably discharged and was at 
that time laboring in the support of his family. The newspapers 
gave a detailed account of his harrowing experience, and when he 
subsequently appeared in St. Louis I visited him in quarantine, 
when he also gave me the details of his life since he had been pro- 
nounced a leper. He has appeared in St. Louis several times, has 
escaped, and has been arrested in various cities in the Union. At 
present, I believe he is in Chicago. The harrowing and frightful 
experience of this man made a terrible impression upon my asso- 
ciates in the clinic and they declared that they would never again, 
until proper facilities were provided for the human care of these 
people, declare a man a leper. This case, from what we know of 
leprosy, is a menace in his peregrinations to many of those he may 
come in contact with. He had infectious lesions; the mucous mem- 
branes of his nose were full of lepra bacilli. Eveiy time he sneezed 



60 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

or coughed in a railroad train or in a cafe, he spra} r ed the surround- 
ings with lepra bacilli. His hands, contaminated with these dis- 
charges, were no doubt infectious in hundreds of ways. He must 
deposit lepra bacilli in the railings and seats of street cars, upon 
those of railway trains, and has been a splendid disseminator of 
the disease. He would willingly, as he said to me, live in a habiltable 
and humane asylum. He did not go near his family, but he wa^ 
nearly driven mad b}^ his isolation and his lack of companionship 
and the accommodations afforded him; therefore he wandered des- 
perately from place to place. 

A few months after that, a man appeared at our clinic, an old 
leper. He had been in the Philippines as a brakeman some 14 years 
before, and he stated that his leprosy did not appear for 12 years 
after his visit to the Philippines. The case of H. appeared 10 years 
after his visit to the Philippines. This brakeman had gone through 
the same experience as the case just cited. He had visited many 
States in the Union, looking for a proper home. He was placed 
in the leper house near the quarantine in St. Louis, but in a short 
while escaped and is now probably wandering from place to place, 
as hundreds of lepers are likewise doing to-day. The mucous mem- 
branes of this man's nose also teemed with the lepra bacilli upon 
actual microscopic examination. He was just as infectious to the 
public as H. Upon cutting out a piece of the skin in both these cases 
lepra bacilli were found by the thousands. 

These cases are only two of at least 10 of this character that have 
come under my personal observation. St. Louis is no different from 
any other large city, and men in the same professional position as 
myself in other cities can give you exactly similar experiences. Both 
of these lepers cited were intelligent men, Americans, deserving a 
better fate. They had served their country. Lepers do not change 
their ideas of humanity, they suffer, they need care; but no matter 
how much humanity may exist in the hearts of their physicians, 
they are powerless to help them under the hysterical dread with 
which leprosy is held by the community and under the lack of na- 
tional laws and national preparation made for these people. 

We have had several Chinese lepers in St. Louis. We have had 
lepers among men of the better walks of life, rich men, men who 
could afford every luxury. These I have advised to immediately 
go to various leper asylums in Europe, where they could receive 
proper treatment. 

The thing that impresses me in connection with these cases and 
the dire need of national regulation and a national home for lepers 
is, in the first place, that we know from the history of the disease 
that leprosy is a communicable disease. We do not, unfortunately, 
know the means or the manner or the method by which it is com- 
municated from individual to individual. In all probability, it 
seems that this must take place through some bloodsucking insect, 
probably the bedbug or the body louse. The insect bites a leper, 
the blood or the skin of the leper is usually teeming with these 
organisms; the insect is thus infected and when it comes in contact 
in its hunger with a leper-free individual the bite may thus act as 
an inoculation. Several physicians of the Department of Public 
Health in their studies upon leprosy in the Philippines and the 



TEEATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 61 

Sandwich Islands have demonstrated lepra bacilli in the intestinal 
canal of the bedbug when allowed to feed upon leprous individuals. 
Again, it may be communicated through accidental inoculation, 
through the inhalation into the mucous membrane of leprous infected 
dust. 

We know from history that segregation is the proper way to 
handle the disease, as after segregation has existed for some years 
in infected countries the disease has gradually disappeared. We 
know this from the earliest authentic history. Leprosy is said to 
have been introduced into Europe from Egpyt, where the disease 
had existed for two or three thousand years before Christ, Egypt 
having been inoculated by the negroes farther in the interior. The 
soldiers of Kome are said to have carried it from Egypt and dissemi- 
nated it over Europe. The disease slowly but surely increased, until 
the populace finally were forced to protect themselves against its 
propagation by the establishment of leper houses. Isolation houses 
are mentioned in France as far back as 560 A. D. The disease in- 
creased so rapidly that during the thirteenth century in France alone 
there were about 2,000 leper asylums and over 200 in Great Britain. 
The study of history shows that isolation is the one great preventive 
in the spread of this disease. This has been many times demon- 
strated and is an undeniable fact. 

It is a law that a race virgin to a given infection is very vulnerable 
to that infection. Herein lies one of the great dangers of leprosy to 
the American people. That is, leprosy has not seemingly existed in 
a great degree up to now in this country, but just for that reason, 
that fact, our ignorance of it, the ignorance of our physicians in the 
recognition of it, the carelessness with which lepers are allowed to 
go in interstate traffic and thus mix with the populace, gives more 
chance for the spread of the disease than in a country where it had 
existed and the government, therefore, were more familiar with the 
methods for the protection of the people. 

The period of incubation of leprosy makes it an extremely dan- 
gerous disease in a nation. The incubation period is the period be- 
tween the time the individual is exposed to the disease and the ap- 
pearance of diagnostic symptoms. The period of incubation in lep- 
rosy in all of the cases I have seen, where the patient probably 
picked it up in the Philippines, in Hawaii, or in some of our island 
possessions, has been at least 10 years; one of them 12 years. Others 
report the period of incubation from 6 months to 25 years. You can 
readily see how insidious, how confusing, how dangerous this dis- 
ease is in this way. One may have leprosy, therefore, for years and 
not know it. The mucous membranes of the nose, where the disease 
usually first appears, may teem for years with lepra bacilli and yet 
the individual be ignorant of his condition. Sometimes during this 
period there are chills and fever and a feeling of illness, without any 
other diagnostic symptoms, the diagnosis usually being malaria, 
until years roll by, when at a certain time the symptoms culmi- 
nate in an outburst of skin eruption, which, by one familiar with the 
disease, is readily diagnosed. But during this period of ill feeling, 
of chills or fever, the disease could be recognized by the microscopic 
examination of secretions from the nose. In 70 per cent of cases of 
leprosy the bacilli are readily demonstrable in microscopic smears 

33993°— S. Rept. 306, 64-1 5 



62 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

made from the nose. Thus, as I have mentioned before, there is a 
source of great danger in sneezing, as by such means the lepra bacilli 
are sprayed into the air. 

Leprosy was probably introduced into this country through the im- 
portation of slaves, probably first in Peru and later throughout the 
States. Statistics made in this country do not give any idea of the 
extent of the disease. In an attempt to compile statistics, the United 
States Public Health Service found that seventy-odd per cent of the 
cases recorded were in individuals at large. Therefore the large 
majority of lepers in this country are at large, only a comparatively 
few under segregation. Any disease known to be communicable un- 
der these conditions must increase. I have known of one instance 
where the disease was conveyed from son to mother and sister, the 
son having been a soldier in the Philippines; another one, where a 
lather conveyed the disease to his wife and daughter, the source of 
the father's infection never being unraveled. He killed himself, his 
daughter died, and his wife has lately died in one of the three State 
leprosaria in this country. In both these instances, the people were 
of high social standing, cultured, educated people. Therefore, one 
can see just from these two instances that the disease is communicated 
and has been communicated from one individual to another in our 
climate. Therefore it will naturally, in the course of the natural laws 
governing infection, spread. 

Senator Weeks. What are the sources ? 

Dr. Engman. The sources at present are our own foci in this coun- 
try, our island possessions through commerce, and any other foci in 
the world where American citizens may come in contact with it. Now, 
that the different countries of the world are so closely connected by 
luxurious and rapid ships and our citizens, through mercantile and 
military connections, are therefore constantly exposed to virile foci 
of this infection, the individual may come unconsciously in contact 
with the disease or be bitten by an insect which has previously fed upon 
a leper, be thus inoculated, come heme, and may thus unconsciously 
disseminate the disease among his relatives and friends. This has 
occurred among soldiers, workingmen, Government, attaches, etc. 

Senator Weeks. Are not those men examined when they come into 
this country ? 

Dr. Engman. I suppose they are given the usual examination. As 
I have said before, one thus inoculated would probably show no signs 
of leprosy when he came into the country and unless he had symptoms 
upon his skin it is doubtful with our present methods if the disease 
could be recognized. To otherwise control it, the secretions from the 
nose of every individual would have to be examined for lepra bacilli, 
unless there were sufficient diagnostic evidence on the skin. There- 
fore, it is not likely that everyone returning from the Philippines or 
from leprous foci could be thus microscopically examined. Even 
then it might escape attention, as the period for the accumulation of 
the virus in the body may not have culminated. As I said, it may 
take years before the organism can be detected in the blood or the 
secretions, or before any symptoms appear whatsoever. We have no 
serum test for leprosy like we have for sj^philis. 

Senator Works. No blood test or serum test, you say? 

Dr. Engman. No; there is no well-proven test except through the 
presence of the bacilli. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 63 

Senator Works. Do you not find the bacilli in the blood ? 

Dr. Engman. It is found in the blood, yes ; but it is very difficult 
to demonstrate, and it is easy to demonstrate in the nasal secretions. 

The Chairman. Is there a very critical examination made of our 
people returning from the Philippines — our soldiers, for instance? 

Dr. Engman. No, sir; not from the standpoint of leprosy. 

The Chairman. I should not think so. 

Dr. Engman. The only examination that can be made of soldiers 
returning from the Philippines would be a very careful examination, 
microscopically, of nasal secretions. Whether that is feasible or not, 
as I have said before, I can not say. 

Senator Works. You would not expect anybody to be sent to this 
sanatorium until it wa^ demonstrated that he was afflicted with the 
disease, would you? 

Dr. Engman. By no means; no. 

Senator Works. You would not send anybody to the sanatorium 
where there was any doubt about it, would you ? 

Dr. Engman. No. 

The Chairman. If there was an asylum of that kind established, 
would your clinic hesitate to make known the existence of cases? 
You spoke of the great horror of these cases you described. 

Dr. Engman. I am sure that none of us would hesitate to make 
a diagnosis of leprosy, if leprosy existed, if there was a proper place 
for the humane care and medical treatment of these cases. My col- 
leagues were so shocked by the horrors of the cases I have described 
that they did not wish to place another individual in a similar situa- 
tion. In our own State, Missouri, leprosy is a quarantinable disease, 
and the patient is at once arrested and isolated. If there were a 
national leprosarium, of course, every case of that kind would be 
reported. I am sure that a great number of lepers in this country are 
not reported from a pure humanity standpoint, and are concealed by 
friends or the family. 

The Chairman. There would, then, be a great many more cases 
reported than anybody knows about now, would there not? 

Dr. Engman. Evidently. Now, as I said, they are concealed, 
there is no place for them to go, they are isolated, placed alone here 
and there at the edge of cities or in huts in the woods, food is brought 
to them by those afraid of the disease or it is thrown to them ; they 
are hounded from village to village. I have known of them to be 
stoned. Only three States in the Union offer them a home. Loneli- 
ness and lack of human sympathy, alone with the horror of them- 
selves, the terror of the disease, a life unthinkable is the lot of a 
leper in this country. 

Senator Beckham. How many cases have you observed in your 
experience ? 

Dr. Engman. Of that kind ? 

Senator Beckham. Of leprosy, yes. 

Dr. Engman. Oh, I have seen, I suppose, several hundred cases 
during my professional career. 

The Chairman. How does the medical profession feel toward 
some measure of this kind? 

Dr. Engman. The medical profession for many, many years, as 
medical literature shows, has earnestly desired an institution like the 



64 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

one for which this bill provides. In 1913, after the dramatic inci- 
dents connected with the cases of leprosy I spoke of occurred, I made 
a special visit to Washington and inquired into the possibility of 
the Government providing a national home for these cases, but found 
that it had proven a very hopeless task to induce the Government to 
take up the matter. At a meeting of the American Medical Associa- 
tion I introduced in the section upon dermatology, on Wednesday, 
-Tune 24, 1914, the following resolutions on leprosy, a motion to make 
this a special order of business being unanimously adopted (reading) : 
To the honorable house of delegates of the American Medical Association: 

The section on dermatology of the American Medical Association respectfully 
submit the following resolutions, which have been unanimously adopted by the 
section on June 24, 1914 : 
Whereas leprosy exists in many foci in this country, and has been statistically 

shown to be on the increase ; and 
Whereas those affected with leprosy are being subjected to most inhuman treat 

ment; and 
Whereas many lepers are traveling in interstate traffic because of the inhuman 
treatment to which they are subjected, thereby constantly exposing the gen- 
eral public to the contagion ; and 
Whereas it is the duty of the Federal Government to control traffic between the 

States; and 
Whereas at the present time the care of the lepers in the United States is a 
great economic burden upon the individual States and is, moreover, of neces- 
sity inadequate from a medical and sanitary standpoint : Therefore be it 
Resolved, That the association recommends the passage by Congress of a law 
for the comprehensive care and control of leprosy by the Federal Government. 

Dr. Engman. This passed the house of delegates of the American 
Medical Association on June 26, 1914. I also placed a similar resolu- 
tion before the American Dermatological Association, a body which 
represents the leper experts of this country, or, rather those men who 
have devoted their lives to the study of skin diseases, of which leprosy 
is a branch. This association also unanimously adopted these resolu- 
tions and recommended that Congress be requested to pass a law for the 
comprehensive care and control of lepers by the Federal Government. 
A joint committee was appointed by both associations — that is, the 
American Medical Association and the American Dermatological As- 
sociation — consisting of Dr. Politzer, of New York ; Dr. Winfield, of 
Brooklyn; and myself, as chairman. I see by the medical journals 
that medical societies over all sections of the United States have 
passed similar resolutions to those above cited. 

The Chairman. Were those resolutions passed? 

Dr. Engman. Yes, sir; they were unanimously passed by both asso- 
ciations referred to. From conversation with prominent medical men 
all over the country I am convinced if there is not some method 
adopted very soon for the control and segregation of lepers in the 
not very distant future we may be compelled to do it on account of 
the then obvious and startling increase of the disease. 

The Chairman. Why do you think there may be a startling increase 
in the disease ? What is your reason for thinking that ? 

Dr. Engman. Having a knowledge of the history of leprosy in the 
various countries of the world, having a knowledge of the nature of 
the disease, having a knowledge of the medical investigations that 
have been made into the disease, judging from my own personal ex- 
perience and reasoning from analogy and a knowledge of other infec- 
tious diseases and their method of propagation, and from earnest 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 65 

scientific consultation with other medical men who have thought 
deeply about this disease, I have come to that conclusion. Those are 
my reasons. 

Senator Works. It is estimated that there are about 800 leprosy 
patients in this country. Do you think that is a fair estimate ? 

Dr. Engman. No. sir. 

Senator Works. What would be your estimate? 

Dr. Engman. It would be absolutely impossible to make an accu- 
rate estimate, but I am positive that the above number of cases is far 
too small. 

The Chairman. You think there are a great many more ? 

Dr. Engman. Oh, yes; there must be at least three times that many. 
For instance, in the statistics of the Marine Hospital before referred 
to, made, I believe, in 1911, Missouri is accredited with one case, when 
I positively know there were at that time in the city of St. Louis 
alone three cases, whereas I am sure that other medical men in the 
city must have had a knowledge of other cases. 

Senator Works. Are there an}- statistics showing what has been 
the yearly increase in this disease ? 

Dr. Engman. In this country ? 

Senator Works. Yes. 

Dr. Engman. No, sir ; the statistics on leprosy are absolutely unre- 
liable in this country and in other countries on account of the nature 
of the disease. Many cases have remained undiagnosed sometimes 
for years in communities, clue to the local medical men not being ex- 
perienced in the symptoms of the disease. Physicians in ordinary 
practice have never seen the disease and therefore probably would 
not think of it in making a diagnosis. I have seen this happen many 
times, even though the disease be far advanced, because it is the last 
disease the average practitioner would think of. 

Senator Works. How many years has it existed in this country ? 

Dr. Engman. I do not know. It certainly did not exist in this 
country before the Spanish conquest of Mexico by Cortez. There 
are no evidences of it among Indian relics or among the pre-Colom- 
bian Indians. It was probably introduced at a very early time into 
South America, Colombia, Canada, and in this country through the 
pioneers or through slavery. 

Senator Works. Up to the present time the increase has not been 
very rapid, has it ? 

Dr. Engman. I do not see that we can estimate the number of cases 
in this country with any accuracy at all. Up to the time of the 
Spanish- American War we did not seem to have very virile foci of 
the disease, but since that time I, for one, have been seeing more 
leprosy; and, as I have said before, the great commercial necessity 
for travel and, therefore, exposure to leprous foci must naturally 
expose citizens of this country to the disease. For instance, I know 
of a very striking case of a young lady who some time ago visited the 
Sandwich Islands. Within a year after returning she developed a 
red spot on the arm, where she distinctly remembered she had been 
bitten by some insect while in the Sandwich Islands. The- case 
proved to be leprosy, and had an exceedingly rapid course. The lady 
did not remember of having seen a leper while there, but this inci- 
dent, although a single one, and I think I have cited others here — ■ 



66 TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 

and any medical man with an experience with this disease can also 
cite similar instances — should demonstrate the fact that leprosy is 
certainly on the increase in this country. I am sure that if statistics 
could be accurately compiled they would demonstrate a startling in- 
crease of leprosy in the last 10 years. 

Senator Works. I was only trying to arrive at the probable in- 
crease, which you suggested as startling. 

Dr. Engman. There is not an apparently startling or dramatic in- 
crease as yet. 

The Chairman. It has not startlingly spread yet, but may do so 
in the future? 

Dr. Engman. That is right, sir. 

The Chairman. When it started in the Hawaiian Islands, in 1831, 
I believe, it spread very rapidly there, did it not ? 

Dr. Engman. Yes, sir; it decimated the population in a compara- 
tively few years. 

The Chairman. It might do the same thing here if it got started, 
might it not? 

Dr. Engman. That has been the history in most of the countries of 
the world where it has existed and insidiously spread, not only in the 
Sandwich Islands alone but in every other country, until segregation 
stopped it. It has been the history of the disease in every country 
that it would insidiously exist and increase in a secret way for a long 
while, when people would awaken to the necessity of adopting some 
measures to prevent its increase. The reason, in these instances, of 
this apparent sudden increase may have been changed climatic con- 
ditions or hygienic, dietetic, or economic conditions. Apparently 
there are a few sporadic cases at first and then, in the course of a 
few decades, an apparent but absolute large increase in .actual 
numbers. 

Senator Works. The increase in the lepers in this country has not 
kept pace with the increase in population, has it ? 

Dr. Engman. That I can not say, because I have no way of com- 
puting accurate statistics. I do not believe that such a compilation 
could be attempted without comprehensive laws to compel physicians 
to report every suspected case and force every leper to come into the 
light. I have for years, ever since the Spanish-American War, re- 
peatedly called attention in medical literature to the absolute neces- 
sity for a leper home and passage of laws regulating the migration of 
lepers and the control of lepers. The medical literature of this 
country teems with articles by thinking medical men upon this 
necessity. 

The Chairman. Is there any positive means for determining the 
disease ? 

Dr. Engman. From the individual? 

The Chairman. Yes. 

Dr. Engman. By the presence of the bacillus of Hansen, the lepra 
bacillus, in the nasal secretions. These bacilli may be also culti- 
vated and microscopically demonstrated from the skin lesions of 
lepers. Those are the most common methods. 

The Chairman. How about the blood when any one of these 
symptoms you described appears? Can you tell from an examina- 
tion of the blood whether leprosy exists or not? 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 67 

Dr. Engman. That can be done by cultural methods, by cultivating 
the bacilli from the blood, which is a very troublesome, intricate, and 
expensive one. 

The Chairman. What have you to say with regard to the cure of 
leprosy ? 

Dr. Engman. I have seen cases that were symptomatically cured; 
that is, for years they have remained without symptoms of the 
disease, but whether they would develop symptoms some time in the 
future I could not say. Certainly, they were symptomatically cured. 
We call it " cured," because there is at that time no evidence of the 
disease apparently remaining. But such cures can only be accom- 
plished by long treatment. 

Senator Weeks. Have there been cases of recurrence of the dis- 
ease? 

Dr. Engman. Yes; I know of three cases which occurred in pri- 
vate practice, but not in public practice, which were apparently cured. 
One was a school-teacher in a large city of Alabama. She taught 
school for many years with hundreds of the lesions of leprosy scat- 
tered over her body. Her nasal secretions teemed with the bacilli. 
She was brought to St. Louis for a diagnosis of her peculiar skin 
disease and several physicians saw her. From a lesion of the skin 
and from the secretion of the nose the bacilli of leprosy were demon- 
strated. She was the principal of a public school in this Alabama 
city, and had held this position for many years. She was a bright, 
intelligent, splendid woman. Just think of what danger she was to 
the scholars under her care. They were constantly exposed to the 
exhalations from her nose and the bacilli from her skin day in and 
day out. This poor woman was horrified over her condition and 
over the exposure that the children had sustained during her long 
term of office. She was sent to Europe and returned symptomatically 
cured and remained so when I last heard of her. 

Senator Weeks. During this time had she communicated the dis- 
ease to any one? 

Dr. Engman. No one can tell. Whether there has been a marked 
increase of leprosy in this section of Alabama where this one woman 
came from, I do not know. Being a principal of a school and com- 
ing in contact with these children from day to day and from year 
to year, it is possible and highly probable that she did communi- 
cate it to others. We can not tell. Leprosy is not a thing to be 
swept into a corner and screened off. We have not been awakened 
to this problem properly. After this idea has been faced for 20 
years and careful statistics taken we can then estimate in a more 
accurate way the source of infection in certain communities and 
the rate of increase of the disease. Now, for instance, in the case of 
this school-teacher, those children should be watched for years and 
followed up when they move to other communities, as they may be 
possible foci of infection if they had contracted the disease. 

The Chairman. You say that symptoms of the disease do not 
break out for 5, 10, 15, or 20 years. How long is it supposed that, 
normally, the disease will develop after a person is exposed? 

Dr. Engman. There is no positive time. Probably six months to 
two years would be the shortest periods of incubation ; but I believe 
in this climate, as I have said before, the period of incubation is 
frequently ten years or longer. 



68 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. You say six months to two years? 

Dr. Engman. I should think that would be the shortest period of 
incubation. 

(Whereupon, at 12.10 o'clock p. m., the committee took a recess until 
2.30 o'clock p.m.) 

AFTER RECESS. 

The committee reassembled at 2.30 o'clock p. m'., pursuant to the 
taking of recess. 

Senator Works. There is no one here representing the State of 
California at this hearing, and I have been asked to state the fact 
that the State Board of Health of California is favorable to this 
measure, which I do very gladly, and I have received resolutions from 
boards of supervisors in our State and others favoring this legis- 
lation. 

The Chairman. Dr. McKean, you may proceed. 

STATEMENT OF DR. J. W. McKEAN, CHIENGMAI, SIAM. 

The Chairman. Dr. McKean, you have given your full name and 
your residence to the stenographer ? 

Dr. McKean. Yes ; my residence is in Siam, but I am an American 
citizen, resident abroad. 

The Chairman. Without asking you any questions, as you have 
to catch an early train, I will ask you to make a statement in regard 
to this bill in your own way and let us have the benefit of your ex- 
perience with regard to leprosy. 

Dr. McKean. It would seem from the testimony that has been 
brought out this morning, as well as from my own observation, that 
this bill is really a very desirable thing. Of course I am not familiar 
with all the details of legislation in America; but, at any rate, we 
know that leprosy is a contagious disease, and practically an incura- 
ble disease; at least, so near incurable that every person who has it 
should consider himself doomed. 

The Chairman. Tell us how much experience you have had with it. 

Dr. McKean. My experience has been for 26 years in this oriental 
country, and 20 of those years, or more, I have been handling lepers 
and treating them. 

The Chairman. Where? 

Dr. McKean. In north Siam, and I now have the pleasure of 
being superintendent of a leper asylum where we have 180 lepers at 
the present time. 

Of course, they come and go ; sometimes they leave, and sometimes 
they die there. We have had in the past seven years about 300 
lepers in our asylum, and I have treated many others as they come 
to us along the highway, because in Siam there is no attempt 
to segregate them; the leper wanders about from place to place. 
We certainly know it is a contagious disease in that country. We 
had one family in our asylum — four persons of that family were 
lepers, and four other persons of the same family died of leprosy 
before these others came into the asylum; eight persons — a father, 
mother, and six children, all lepers. The contagiousness of the dis- 
ease, of course, is acknowledged by all medical men the world over. 
As to how the contagion is carried, we do not know, but my observa- 



S. Doc. 306, 54-1. 




KWANGJU LEPER ASYLUM, KWANGJU, KOREA. 



S. Doc. 306,64-1. 




CHIENGMAI, SIAM, LEPER ASYLUM. 



TREATMENT OE PERSONS AFFLICTED WITH LEPEOSY. 69 

tion would lead me to believe that in the East, at least in the Tropics, 
it is probably carried by blood-sucking creatures, such as the bedbug, 
and probably the itch parasite; that it is probably communicated 
also by the fact that the leper member of the family sits with the 
other members of the family at a small table about 18 inches in diame- 
ter. They sit closely around this table, and if the leper member of 
the family sneezes or coughs over this table, the food on the table is 
likely to be contaminated by discharges from his nasal mucus. The 
bacilli of leprosy appear in the nasal mucus early in the disease, and 
that that is possibly one of the ways in which the disease is conveyed 
to others. These things are problematical and merely surmise, but 
they seem to be plausible. 

We have two remarkable instances in history of the rapid spread 
of leprosy. One was in Europe during the Middle Ages, when 
leprosy came from the Orient and spread all over Europe in such a 
rapid manner that all the Governments of Europe and all the clergy 
were very much alarmed at the frightful spread of the disease, and 
very stringent measures were adopted and very stringent laws en- 
acted. The lepers were forced into leper asylums, and during the 
four centuries from 1094 to 1472, there were no less than 21,000 leper 
asylums, large and small, built in Europe. In Great Britain alone 
there were 112, and in France there were 2,000, and the result of this 
stringent legislation was that leprosy practically disappeared from 
Europe, and instead of there being thousands and thousands of cases, 
there were very few of them left. The last British leper died more 
than a century ago. 

Senator Works. Just what was the restriction in their legislation 
that brought about that result? 

Dr. McKean. It was forcing them into these leprosariums or leper 

refuges, by law ; they were supposed to be dead to the world ; funeral 

services were read over them, and they never appeared again outside. 

While it was very stringent and very trjdng to those who were 

treated, still it was for the public good, evidently. 

Then we have in the history of Hawaii a remarkable spread of the 
disease. About 1835, I believe, the first leper came to the Hawaiian 
Islands, and within a period of 50 years it spread over the islands 
until there were many thousands of them. 

When our Government took over those islands they found a fear- 
ful condition there. I think a still more remarkable instance of 
what can be done by segregation is furnished by the Philippines. 
When the United States took over the Philippines they found lepers 
everywhere, and it was estimated there were at least 1,200 new cases 
every year. Dr. Victor G. Heiser, who was made director of public 
health, and held that position for 12 years, personally superintended 
the segregation of nearly 9,000 lepers in the Philippines. They 
were segregated on the Island of Culion, where they were given 
every possible comfort. 

Here they have their own form of government, their own police 
court, and special coinage for their individual use, and they live in 
comfort. At the present time we have on that island only 3,500 
lepers, showing that of these nearly 9,000 lepers the rest have passed 
away according to the natural order of the disease, and the spread 
of the disease is practically inhibited in the Philippines, and it is 
probable that these other 3,500 lepers will soon pass away in the 



70 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

same way, under a condition of comfort and without menacing other 
people. 

The American Government in the Philippines enjoys the dis- 
tinction of being the only Oriental country in the Avorld that has 
segregated the leper, and where the disease is not permitted to 
spread. 

The Chairman. That is done under our management in the 
Philippines ? 

Dr. McKean. Yes, sir. 

The Chairman. Is that the result of a statute enacted by Con- 
gress, or just the way they handle it there? 

Dr. McKean. I can not tell you that. It is some Philippine law. 
Whether the Congress of the United States did it or not I can not 
sa} r . 

We have those two remarkable instances of the spread of leprosy, 
a d then we have also those two remarkable instances of the control 
of the disease by segregation. 

We should be impressed with the fact that not only is this pro- 
posed leprosarium for the care of the lepers, who are now hounded 
about worse than a dog about the streets, but it would also relieve 
the public from the danger of contagion and rid our United States 
from the curse of leprosy. 

Senator Works. Do you know how many new cases they are segre- 
gating in the Hawaiian Islands now? 

Dr. McKean. I am not familiar with the conditions there. 

Senator Works. Or how it is in the Philippines ? 

Dr. McKean. It is supposed that every leper in the Philippines 
has been segregated. There are possibly some in the distant villages. 

Senator Works. That is what I wanted to ascertain — whether any 
new cases are being discovered and segregated? 

Dr. McKean. No; there are no new cases being discovered now; 
there has been a very diligent search throughout the whole of the 
Philippines, conducted in a very humane and kindly way, but a very, 
very thorough search, however, even into the distant mountain dis- 
tricts; apprehending and bringing to Culion every leper; so now 
there are no cases of leprosy in the Philippines, so far as is known, 
outside of those isolated at Culion. 

The Chairman. What do you think as to the advisability of such 
legislation as this bill contemplates? 

Dr. McKean. It seems to me eminently desirable and proper, for 
the good of the country and for doing away with this fearful dis- 
ease; for we do not know, as Dr. Fox indicated this morning and as 
others have also indicated, what day it will begin to spread rapidly 
and prove a tremendous curse, too difficult to handle, while at the 
present time it is comparatively easy to handle. 

The Chairman. Do you think it reasonable to suppose, judging 
from the past history of the disease the world over, that it is liable 
to spread if we do not take some measure to segregate it or prevent 
its spread? 

Dr. McKean. These two ancient examples, one from the eleventh 
to the fifteenth century in Europe and one here recently in Hawaii, 
would seem to indicate that. At times it shows a wonderful recru- 
descence. For instance, many of my patients seem to be cured ; they 
sleep and eat well and seem to be thoroughly comfortable, and then, 



S. D 


oc. 306, 64-1. 




PLATE 8. 






'' "' -J 








^.^ „4&J 








tejN«i .. 






rlr^ 



CULION LEPER COLONY, PHILIPPINE ISLANDS, AT CLOSE RANGE. 



S. Doc. 306, 64-1. 







TUNGKUN, CHINA, LEPER ASYLUM. 



S. Doc. 306, 64-1. 




A SECTION OF AN INDIAN LEPER ASYLUM, PURULIA. 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 71 

after you think they are cured, the disease breaks out in all its origi- 
nal vigor, and the patient goes from bad to worse. 

The Chairman. Have you known of cases where they were actu- 
ally cured and where the disease never broke out again? 

Dr. McKean. I have not known of any such case. We have been 
using the Chaulmoogra oil, but I do not know of any complete cure. 
Many of them are apparently cured, and most of them improve very 
much with its use. 

The Chairman. You mentioned a Dr. Heiser, who is in charge of 
the work in the Philippines. Who is this Dr. Heiser — is he a citizen 
of the United States ? 

Dr. McKean. Yes; he is a citizen of the United States and a 
surgeon in the United States Public Health Service. 

The Chairman. He is one of the doctors in the Public Health 
Service ? 

Dr. McKean. Yes ; he was at that time, and he is still. 

The Chairman. Doctor, we are very much obliged to you, sir, and 
we are sorry that you have to rush away. We thank you very much 
for coming here. 

Dr. McKean. Not at all, gentlemen ; I thank you. 

The Chairman. We will now ask Mr. Danner to take the witness 
chair. 

STATEMENT OF W. M. DANNER, AMERICAN SECRETARY OF THE 
MISSION TO LEPERS. 

The Chairman. Are you a physician, Mr. Danner? 
Mr. Danner. No, Senator Ransdell ; I am only a layman, in charge 
of the secretary's office for the American Council of the Mission to 
Lepers, an organization interested in world-wide work for lepers. 

The Chairman. How long have you been studying leprosy in con- 
nection with your official duties? 

Mr. Danner. Five years. May I stand up, as I would like to show 
a map and some photographs that will make my presentation very 
brief and easily understood? The large map I hold in my hand 
readily calls attention to the care of lepers as a world problem. The 
Mission to Lepers is interested from the standpoint of helping where 
ever lepers live. This map has been shaded heavily to indicate the 
countries where the most lepers are found, and by light shading to 
indicate in some other countries where only a few are found. Many 
people are surprised to find that there are lepers in Iceland even. 
Mrs. Wilbur F. Crafts is here to-day. She has visited the Iceland 
colony of lepers. I hope she may tell of that colony. 

The Chairman. What does the red on your map indicate? 
Mr. Danner. The dark red indicates countries where the greatest 
number of lepers are living, and the light shading indicates coun- 
tries where there are some lepers, but not a great many, in some coun- 
tries only a few cases. You will notice the light shading across the 
part representing North America. While these lepers constitute a 
menace to the community, even though they are lepers they are still 
human beings. Is there any question whether the Nation is called 
upon, for the sake of humanity, to protect other members of society, 
to take such measures as will at once operate to better the condition 
of the leper, and throw out proper safeguards against the spread of 



72 TREATMENT OP PERSONS APFLICTED WITH LEPROSY. 

the disease? Newspaper reports tell how a business man at Bay City, 
Mich., on a trip to Iowa, was suddenly taken sick, went to see a 
doctor, and the doctor diagnosed his trouble as leprosy. Then he was 
sent off to live in a smallpox hospital at Centerville. He said " I do 
not want to live here ; I want to pay my way back home." They said. 
" No ; you can not leave here. You must go to the detention hospital." 
He said, " No ; I want to go home ; I can pay my way." He was told. 
so the newspapers said. " If you can get permission from the State 
boards of health of Iowa and other States through which you will 
have to pass, and can hire a freight car, and will agree to burn it up 
when you get to your destination, we will let you go back." I have 
been told by a friend that he did not go away in a freight car, but 
it was a very unfortunate and expensive way for a sick man to have to 
get back home. 

The Chairman. Is there any reason why yon should not tell us 
how he got back? 

Mr. Danner. My friend there said he hired an automobile to take 
him back home. 

The Chairman. And went all the way from Iowa to Bay City, 
Mich., in an automobile? 

Mr. Danner. Yes; that is the story as told to me. This method 
provided the only way that he could travel without being interfered 
with on his way. 

The Chairman. In connection with your map, would you mind 
stating how many lepers there are estimated to be in the world? 

Mr. Danner. Yes, sir; there are three estimates. Our mission 
officers estimate the number as at least 1,000,000. Dr. Victor G. 
Heiser, in January World's Work, estimates that there are 2,000,000. 
and the Medical Review of Reviews, a medical journal, in a recent 
issue, estimates the number at 3,000,000. Even if there are only 
1,000,000 lepers in the whole world, the number is large enough to be 
a world menace. I would like to emphasize the importance of this 
question, even to the States in which there are no known lepers living 
at this time. 

There was a schoolboy in Upton, Mass. — not a native of Massa- 
chusetts — mingling with the boys and girls in his class and sitting 
at the same desks with them. For at least two years he was being- 
treated by a doctor in Upton for some skin trouble which the Upton 
doctor did not seem to understand. Finally this doctor gave the 
case up and referred the boy to the Massachusetts General Hospital 
to see if he could there find out what was the matter. The experienced 
doctors at this hospital examined him and diagnosed his trouble as 
leprosy. Then by the law of Massachusetts he had to go and live 
in the leper colony. No further case of leprosy at Upton has resulted 
so far from this case, though he had mingled freely with the other 
children in the school and around the village. We now know that the 
leper germ is very slow to make its manifestations, and notwithstand- 
ing that there has been no new case reported in five or six years there 
still might be some cases develop in the future. The school building 
was thoroughly fumigated. The boy's books and his desk were 
burned. 

The Chairman. But cases of the disease may still develop from 
that later? 



S. Doc. 306, 64-1. 




BALDWIN HOME, KALAWAO, MOLOKA 



S. Doc. 306, 64-1. 




5ROTHER JOSEPH DUTTON, WHO SUCCEEDED FATHER 
DAMIEN WHEN HE CONTRACTED LEPROSY IN CARING 
FOR LEPERS AT MOLOKAI. H. I. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 73 

Mr. Danker. Yes. It is entirely possible that it may develop 
many years later. In fact, the gentleman on this committee who this 
morning spoke of his experience among the lepers 30 years ago may 
develop a case even yet. It is possible that I may have it some day. I 
do not think I will. I hope not. We think leprosy contagious by 
prolonged contact. The Mission to Lepers is interested in 90 asylums 
throughout the world. The only missionary connected with these 
asylums who has leprosy is a woman who contracted the disease 
before she went to work for the lepers, and she does not know how 
she contracted it. 

The Chairman. Have you any idea how many lepers there are in 
the United States? 

Mr. Danner. My estimate, Senator, is based altogether on per- 
sonal observation of unreported cases and the estimates I have heard 
made by physicians who have been caring for lepers in the United 
States. I have referred to the number as approximately 500. This 
would be my own personal estimate. Perhaps I am more conservative 
than some others, but there is no way of proving that there are not 
3,000 at the present time, as estimated this morning by Dr. Engman, 
of St. Louis. 

Mention was made this morning of the Hawaiian leper colony. 
I have here just a small photograph of the station in Molokai, where 
Father Damien spent 17 years of his life. Many people have gotten 
the wrong impression from the stories circulated about Father 
Damien, indicating that one working among lepers will always con- 
tract leprosy. His successor has spent 30 years there and has never 
had a sign of it. Here is his photograph. 

The Chairman. Who was his successor? 

Mr. Danner. Brother Joseph Dutton, who by living a clean, care- 
ful life seems quite immune from the disease. I would plead for a 
national leprosarium because the lepers are human beings and deserve 
proper humane treatment and because this care, when given in the 
right way, is appreciated, and best of all, because, through a proper 
segregation of lepers, the number of cases of the disease may be 
quickly reduced and in a reasonable time the terrible malady eradi- 
cated from a given territory. Dr. Victor G. Heiser, in " Fighting 
Leprosy in the Philippines," appearing on page 310 of the January 
World's Work, tells how some lepers in the Philippine colony have 
been discharged as cured and how the total number of known lepers 
has been reduced from over 8,000 to 3,600 within a period of less 
than 10 years, all by segregation and care for the Philippine lepers. 

The Chairman. You may insert the whole article in the record. 

Mr. Danner. Very well, sir. Thank you. 

(The article referred to was subsequently submitted, and is here 
printed in full, as follows:) 

Fighting Leprosy in the Philippines — What Has Been Done in One of the 
Possessions of the United States to Combat This Most Dreaded of All 
Diseases— Hopeful Results From the Use of Chaulmoogra Oil. 1 

[By Victor G. Heiser. M. D.] 

Dr. Victor G. Heiser, who writes the following account of his experiments on 
lepers in the Philippine Islands — experiments that promise to result in a per- 
manent cure of one of the most dreadful and famous diseases in history — was for 

* World's Work. January, 1916. 



74 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

more than 10 years in charge of the sanitation of the Philippines. When he 
went there experienced Europeans ridiculed his proposals to make orientals pay 
any attention to sanitation. As a result of the work of Dr. Heiser and his as- 
sociates, however, the Philippine Islands to-day are more sanitary than the 
United States. The influence of his work has so spread throughout the East 
that so formidable a task as cleaning up China is now being undertaken. Dr. 
Reiser's encouraging report on the new leprosy treatment, as well as his sympa- 
thetic picture of those pitiable people who, in a peculiar sense, are wards of the 
Nation — the lepers of Culion — is one of the most creditable chapters in recent 
American history. — The Editors. 

In the last few months 23 lepers have been discharged as cured from the hos- 
pitals of the Philippines. In the United States Health Reports the writer an- 
nounced the " apparent cure " of 6 individuals who for several years had suf- 
fered from this disease. In these latter cases the official publication had been 
withheld for two years, for the reason that in many previous experimentations 
with leprosy patients apparently restored to complete health had subsequently 
relapsed. In these cases there had been no permanent cure — the infection, one 
of the most insidious known, had simply existed quiescent, unperceived, only 
to break out again under provoking circumstances. It was safely assumed, 
however, that anyone " cured " of leprosy who remained cured for two years 
could be regarded as permanently free from the disease. Since describing these 
six cases another year has elapsed and all six are still, to outward appearances, 
in excellent health. The recent news from Manila, recording the cure of 23 
more lepers, is naturally very encouraging. Reports from Hawaii, the Straits 
Settlements, the Malay States, India, and certain parts of the United States — 
leprosy, brought in by immigrants, prevails here to a greater extent than most 
Americans understand — also record satisfactory progress. 

The outlook for a permanent cure is therefore very hopeful. It will take many 
years and exhaustive experimentation in all parts of the world to establish this 
fact definitely ; but we have already obtained results that justify the widespread 
use of the treatment. 

It sometimes seems as though the mere intuition of the less progressive peoples 
grasped more than the scientific wisdom of the Western World. The common 
people of the East can often merely by a glance detect a leper when the American 
or European physician, after a clinical examination, fails to find the disease. 
In such cases bacteriological examination will show, nine times out of ten, that 
the ignorant native is right and the western physician wrong. Similarly those 
leper-ridden lands have had for centuries their " cure " for leprosy. This is the 
<haulmoogra oil- — an oil obtained from a tree which is indigenous to India. The 
people of India and other eastern countries have often asserted that this oil, 
if taken persistently enough, would destroy this disease. They have abundant 
stories of cures obtained in this way. Some years ago medical men in this 
country, especially Prof. Dyer, of New Orleans, attempted to test these claims. 
Prof. Dyer reported the successful use of chaulmoogra oil in the treatment of sev- 
eral lepers in the Iberville Parish leper colony, Louisiana. Later this treatment 
was used with some success in the Philippines. But the trouble was that very 
few people could take the medicine. They became so nauseated from its use 
that they could stand it only a few months at one time. Several years of con- 
tinuous treatment was believed to be necessary to produce a cure. 

Evidently the East Indians were right. The western experimenters saw indi- 
cations enough that chaulmoogra oil exercised a decidedly antagonistic in- 
fluence upon leprosy. Perhaps the scattered cures reported represented the 
patients who had had sufficient moral courage to keep up the treatment for 
years, or whose physical tenements were so constituted that nausea had not 
resulted. What western science has accomplished is the discovery of a method 
of administering this chaulmoogra oil that does not produce nausea. Chaul- 
moogra oil is mixed with camphorated oil and resorcin and given hypodermi- 
cally. All the progress made in the treatment of leprosy is due to this simple 
procedure. 

There are perhaps 2.000.000 lepers in the world at the present momenl. 
From earliest times this disease has aroused intense interest. The fact that 
leprosy is one of the few diseases described in the Bible probably explains this. 
It will, therefore, interest the people of the United to learn that their Govern- 
ment has been one of the first to deal with the problem of its treatment and 
eradication on a large scale, and that these efforts have been more successful 
than any which have heretofore been made. If our annexation of the Philip- 
pines leads to the cure of leprosy, certainly that itself will justify us. 






TREATMENT OP PEESONS APPLICTED WITH LEPEOSY. 75 

When Uncle Sam undertook the solution of the leprosy problem in the 
Philippine Islands, the number of lepers there was estimated from six to thirty 
thousand. A census disclosed that the number did not exceed 6,000. Obviously 
the desirable thing was to cure the victims and to prevent the spread of the 
disease. It was soon decided that one of the first steps would be to segregate 
all lepers on a suitable island, where they would not endanger the remaining 
population. It was indeed horrible that each year more than a thousand 
Filipinos should contract leprosy, which, after all, is nothing more than living 
death, because the disease drags along for many years and the victims die 
usually when they contract some intercurrent malady. 

Until recently, as already said, all treatments for leprosy have ended in 
failure. From time to time there has been an isolated case here and there 
reported to have been cured. But generally the diagnosis was not satisfac- 
torily confirmed, or the question was complicated by the fact that occasionally 
leprosy undergoes spontaneous cure, or there were other doubts cast upon the 
reliability of the reports. Experience with many thousand lepers in the Philip- 
pines has shown that occasionally there are individuals who alternately recover 
and relapse, and during the period of temporary recovery it is impossible to 
make a diagnosis even by microscopical methods. 

We had a recent illustration of this in our own country. The case of one 
victim, a man named Early, has received world-wide newspaper publicity. One 
set of experts declared him to have leprosy and other experts pronounced him 
free from the disease. It would seem quite possible that he may have been 
inspected by the experts at different periods of the disease and that these may 
have corresponded to periods of recovery and relapse. Subsequent develop- 
ments have shown conclusively that he is undoubtedly a leper. That caution 
is necessary in announcing a cure for leprosy will, therefore, be apparent. Up 
to the present time no one has claimed that any considerable number of cases 
have been cured by any one form of treatment. It is, therefore, of more than 
ordinary importance that in the Philippines the use of a chaulmoogra oil mix- 
ture has resulted in the practically demonstrated cure of 6 cases and the 
probable cure of 23 more. 

The present stage of the development of the treatment herein described does 
not warrant the belief that anything like a specific for leprosy has been found, 
but experience does show that it gives more consistently favorable results than 
any other that has come to our attention, and it holds out the hope of further 
improvement. The situation may be summed up as follows : It produces appar- 
ent cures in some cases, causes great improvement in many others, and arrests 
the progress of the disease in every instance in which we have tried it. Experi- 
ence also shows the great desirability of further trial in the hands of other 
workers in different parts of the world. Finally, it is always important to 
remember that there are many treatments which apparently cause some im- 
provement, and it not infrequently happens that when cases of leprosy are 
placed under better hygienic conditions and have hospital care the disease is 
often arrested, in a few instances improvement results, and apparent cures may 
take place without any treatment. 

This treatment is only one phase of the work which the United States is 
doing in the Philippines for its lepers. Probably no nation does so much for 
these, its especially unfortunate wards. The island of Culion, which was 
selected as the site of the leper home of the Philippines, is a beautiful island 
approximately 15 by 30 miles in dimensions. It is located about 200 miles south- 
west of Manila and forms one of the Calamianes group. It has many fertile 
valleys, and the whole island is covered with an abundance of trees and tropical 
vegetation. The site was chosen because it was well isolated, sparsely in- 
habited, had plenty of good fresh water, an excellent harbor, and offered ex- 
cellent opportunities for the lepers to engage in agricultural pursuits. 

It is difficult to appreciate the amount of work involved in constructing a 
complete town on a remote and deserted island. Under natural conditions a 
town comes into existence over a period of years, and many private individuals- 
are concerned in its building. To bring a complete town into being for the use 
of other persons has very seldom been done. It meant the laying out of streets 
and alleys, the building of more than 400 dwelling houses, the erection, of a 
theater building, a town hall, a school building, a modern piped water supply, 
the necessary reservoirs, the installation of a sanitary sewer, the building of 
docks and approaches, warehouses, dining halls, hospital buildings, lighting 
systems, post office, store, a refuse-disposal plant, cemeteries, and the erection 



76 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

of suitable buildings for nonleprous employees — in brief, all the modern con- 
veniences that one would expect to find in any up-to-date, well-ordered town. 

The work was accomplished only after many heartrendering experiences. At 
one time 300 laborers ran away at the first report that a shipload of lepers was 
to arrive on the island. It was only after a number of weeks of painstaking 
effort that a new supply could be secured. Skilled mechanics had no desire to 
undergo the isolation, some quit after a few days' work, and the class that could 
be induced to go often lacked skill and made blunders which sometimes took 
months to correct. Construction work on even smaller projects is often diffi- 
cult in the United States, so that our experience on this remote island in the 
Pacific Ocean can perhaps better be imagined than described. There was no 
telegraph, and mail steamers arrived only once every three weeks. Captains of 
steamers carrying building materials who were unfamiliar with the port often 
would anchor miles away, and the supplies had to be laboriously landed in 
small boats. Many of the materials had to be obtained in the United States 
or Europe, and this alone required six months or more. Sometimes a part of 
a machine would be lost in transit — another six months would be needed to 
replace it. The colony was finally completed, and, though it is by no means 
perfect, it represents an amount of time, labor, thought, and perseverance that 
is not obvious in the finished product. 

While the construction work was going on at Culion a campaign of education 
with regard to leprosy was conducted throughout the Philippine Islands. Upon 
the instance of the Governor General the provincial governors were asked to 
make every effort to tell the inhabitants of their Provinces a few salient facts 
about the manner in which the spread of the disease might be lessened. They 
were requested to start a campaign of education in order that the masses might 
learn the dangers of leprosy. They were also to inform their people that by 
modern methods there was reasonable hope that the number of new cases could 
be greatly reduced, and that by special care the course of the disease might bo 
greatly modified and even steps taken toward a cure. A few months later a 
Filipino medical officer who could speak the dialect would call at the Province 
and give public lectures on leprosy, and often, with the aid of lantern slides, 
would show views of the leper colony which was then under construction. As 
soon as the colony was ready to receive lepers the present writer would go to 
such Provinces with a steamer and invite those who were afflicted with the 
disease to accompany him to Culion. 'It was hoped, by using methods of per- 
suasion rather than of force, that much more rapid progress could be made in 
the segregation of the unfortunates. Furthermore, it was hoped, after the 
lepers arrived at Culion and found that they were provided with good food 
and living quarters and an ample supply of clothing, all without cost to them, 
that they would write home and encourage other unfortunates to come. This 
proved to be the case. Briefly, the great majority of the lepers in the Philip- 
pine Islands were transferred to the island of Culion without the use of force. 
When it is remembered that this frequently involved separating husband from 
wife, mother from child, brother from sister, friend from friend, and. further- 
more, that family ties among Filipinos are very strong, it will be appreciated 
what great forbearance the Filipino public showed in not opposing this public- 
health measure and what it meant when they assisted to carry it into effect. 
In all, more than S,000 lepers were transferred to Culion, and, so far as known, 
every person in the Philippine Islands who is afflicted with the disease has now 
been segregated. The present status of the problem is in striking contrast with 
that of 1906, when lepers were encountered almost everywhere without any 
restrictions. In a number of instances they worked in cheese factories, as 
salesmen in grocery stores, as coachmen, school-teachers, clerks, in tobacco 
factories, and at other similar pursuits. One of the gratifying results of the 
segregation of the lepers was the discovery of persons who were suffering from 
other diseases who had been classed as lepers and had been compelled to live 
with them. It often happened that these persons suffered from maladies that 
could be readily cured, and in such cases they were taken to Manila or other 
places for treatment, and upon their recovery they were restored to their homes 
and friends. 

The present colony numbers about 3,500 lepers. They live in more than 400 
nipa palm houses, each of which is large enough to accommodate from five to 
seven lepers. In addition there are reinforced concrete houses which are di- 
vided into six apartments, each of which is suitable for twelve persons. These 
houses are built with ventilated tile roofs and are especially adapted for hous- 
ing persons afflicted with this disease ; the ventilation is of particular impor- 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 77 

tance because the disease gives rise to very unpleasant odors. In front of each 
house is a small flower garden, and every effort is being made to instill suffi- 
cient civic pride in the lepers to maintain them ; but so far these efforts have 
not met with much success. 

The lepers are given all possible liberty, and to a large extent are controlled 
by regulations which they themselves make. They are allowed to punish 
offenders against their own regulations. They are privileged to elect their own 
mayor and councilmen. A police force composed entirely of lepers has been 
organized, and it is its duty to see that the town is kept in goad sanitary con- 
dition as well as to make arrests of offenders against their own ordinances. 
Each councilman is responsible for the proper housing, good order, and adjust- 
ment of complaints of the people in the section of the town which he represents. 

The question of the lepers contributing something toward their own support 
has received most careful attention, but on closer consideration it has been 
found that not much assistance in this direction can be expected. The disease 
soon produces contractions of the limbs, destruction of tissue, losses of fingers 
and toes, nervous involvements which result in loss of muscular power, and 
general debility. Only a small proportion of them are capable of performing 
sufficient manual labor necessary to supply food for themselves. There are 
many lighter occupations in which a fair percentage could engage, yet the arti- 
cles produced would not be of a kind useful to themselves. The repugnance 
which the public has for things handled by lepers, even though rendered safe 
by sterilization, would preclude the possibility of selling these products at a 
profit. Then again, so many of them are bedfast, and the wounds and ulcers 
of others require so much attention, that many of those not yet so badly 
afflicted must devote their time to those not so fortunately situated. Domestic 
duties, cooking, the making of clothes, laundry work, cleaning, the care of 
streets, and the repairing of buildings require the entire time of many more, 
so that the sum total of the remaining effective labor is very small. 

The question of raising cattle is now under consideration. Apparently this 
should be a light occupation in which our lepers might be successful. On ac- 
count of the fact that cattle do not contract leprosy, it would seem that the 
public would not object to the meat of such animals if it were placed upon the 
market. 

At first it was hoped that the able-bodied lepers would be glad to perform 
such tasks as might be assigned to them, but it was soon found that even a 
leper who receives free board, lodging, hospital care, and clothing from the 
Government does not care to work for that Government without receiving com- 
pensation, notwithstanding that the labor is for his own benefit. There are 
many things to be done each day in Culion. The streets must be swept, the 
garbage cans emptied, assistance rendered in the hospital, and supplies carried. 
Each leper thinks it is the duty of the other to do the work, and so it goes in 
an endless circle. To meet this difficulty it seemed desirable to change artificial 
conditions of institutional life more nearly to resemble the conditions prevailing 
in ordinary communities. With this end in view, a store has now been started 
at which anything produced by a leper may be sold. There is also kept for sale 
a stock of such things as the lepers may wish to buy. This store is beginning to 
exert a very favorable influence. For example, nearly a ton of fish is offered 
for sale by the lepers every day. Milk from the goats and special vegetables 
may now be obtained for the sick. In connection with the store there is a post 
office, with a leper postmaster in charge. All outgoing mail is disinfected. 
When it is ready, a nonleprous employee collects it and places it aboard the 
mail steamer. 

A special currency has been coined for the exclusive use of the lepers. The 
denominations are the same as those of the regular Philippine currency. If a 
leper has occasion to send money out of the colony, he can purchase a regular 
money order from a nonleprous clerk, who mails it for him. 
- Briefly, then, the United States has established the world's largest leper 
colony. In the course of a few years the feat of gathering up more than 8,000 
lepers has been accomplished without creating any serious disturbance. The 
treatment for leprosy has been greatly advanced. The lepers themselves, in- 
stead of being shunned, often wanting for food, and driven from pillar to„ post, 
now have a comfortable home where they are welcome. And finally, due to the 
decreasing number of new cases, hundreds of unfortunates who were formerly 
doomed each year to contract this most loathsome disease are now saved from 
this horror. 

33993°— S. Rept; 306. 64-1 6 



78 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



mittee, to call attention to a United States Public Health Service 
Report, Supplement No. 20, issued October 16, 1914. Will the mem- 
bers of the committee note one picture opposite page 14 of this 
report, showing the results of the Chaulmoogra oil treatment; the 
change in the appearance of the leper is shown by the pictures oppo- 
site page 15. 

Neither Dr. Heiser nor anyone else, so far as I know, has claimed 
that this is an absolute cure. It may only arrest the disease. Whether 
leprosy will recur can only be determined by observation through a 
long period of time. However, the last time I talked with Dr. 
Heiser he told me that 7 cases had taken the treatment in which all 
evidences of the disease had disappeared for more than three years, 
and 23 cases had lost all trace of the disease and been apparently 
cured for two years, and that 200 additional cases had been sub- 
stantially improved. The remedy has shown uniformly wonderful 
advantages to all the patients who have taken it. 

If I needed any further reason to convince me that this legisla- 
tion is needed I would find it in the appearance here to-day of the 
busy specialists from New Orleans, Minnesota, Missouri, New York, 
Massachusetts, Maryland, and elsewhere. If these men, from their 
own professional relation to leprosy, deemed the national leprosarium 
a feasible method for the care of lepers, surely their opinions should 
be regarded as evidence unmistakable in its importance. 

These pictures showing types of leprosy and some asylum build- 
ings, which I leave with the committee, are so marked that each 
one tells its own story. Dr. Dyer referred this morning to the little 
chapel for lepers. There is a beautiful little Catholic chapel and a 
very pretty little Protestant chapel for the lepers at this Louisiana 
station. I would like to go on record as expressing my hearty ad- 
miration for the perfectly wonderful way in which the sisters at 
Carville, La., take care of the lepers there. 

The Chairman. What sisters are those? What order? 

Dr. Dyer. St. Vincent de Paul. 

Mr. Danner. I said to one of the sisters, after she had dressed a 
very bad case in my presence, and the patient had been wheeled 
away in his chair, "Does this case disturb you much?" and she said, 
"Not now; it used to, but the mosquitoes bother me more now." 
These nurses are earnest and faithful in the illustration of love for 
this work. 

May I submit a letter, Senator Ransdell. which I received this 
morning at your office from Dr. Conley. of the New York department 
of public charities? He is superintendent of the Metropolitan Hos- 
pital and has special supervision of the lepers. 

The Chairman. Yes. 

(The letter referred to is here printed in full, as follows:) 

Department of Public Charities, 

New York, February 11, 1916. 
Mr. W. M. Danker, 

United States Senate Building, Washington, D. C. 
My Dear Mr. Danner: Yours of February 9 just received. It will be im- 
possible for me to go to Washington on Tuesday next, although I would like to 
very much. 

I do not see how there can be any argument against the establishment of the 
leprosarium, and I think everything is in favor of such an institution. 






TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 79 

At the present time we have eight lepers in this hospital, one having died a 
few weeks ago. In the City Hospital there are two and in the Kings County 
Hospital, Brooklyn, one. I do not believe that there are any others in any of 
the hospitals in the city of New York, although there may be many wandering 
about at large in the city. 

I have just called up the contagious division of the department of health and 
asked them for the number of lepers in the city of which they have a record, 
and I find it to be 8 in addition to the 11 above mentioned, and they estimate 
that there are about 50 in Greater New York. Of course, outside of the 19 
known cases, it is simply an estimate. 

Hoping that you will be able to show the Senate committee that it is an 
absolute necessity, I remain, 

Sincerely, yours, Walter F. Conley, 

Medical Superintendent. 

Mr. Danner. I should like also to call the attention of the com- 
mittee to the Public Health Report for 1906. 

(The report referred to is here printed in full, as follows :) 

NECESSITY OF A HOME FOR LEPERS IN THE UNITED STATES. 
[Report for 1906. (P. 216 — Public Health and Marine-Hospital Service).] 

While on the subject of leprosy, it is pertinent here to narrate certain events 
during the past year which emphasize the necessity of a home for lepers under 
Government control. It will be recalled that a bill for the establishment of 
such a home was introduced in the Fifty-eighth Congress. This bill was passed 
by the Senate, was reported on favorably by the House Committee on Inter- 
state and Foreign Commerce, but on the last day of the session failed to pass 
the House. 

In June, 1906, there arrived at Elkins, W. Va., where two of his brothers 
lived, M. R., a native of Syria. He had landed at New York from Beirut in 
1902, at the age of 17. Two years after landing in American he developed 
symptoms of leprosy For some time he worked in a cotton factory in Maine, 
until he was physically unable to work longer. 

Three weeks after his arrival at Elkins, W. Va., the city health officer recog- 
nized the case as one of undoubted leprosy. The said health officer reported 
the case to the secretary of the State board of health, who in turn reported 
it to the bureau by telegraph and requested advice as to his disposition. Reply 
was sent that the patient did not come within the provisions of the immigration 
law relating to deportation, the time limit within which he could be deported 
having expired ; that there was no national leper home to which he could be 
sent ; and that there was no appropriation under which he could be cared for 
by the service. 

The patient desired to return to Syria, and undertook to reach New York 
by the Baltimore & Ohio Railroad, but according to press accounts was turned 
back at Philadelphia, and was switched off in a freight car onto a siding at 
Golden Oak, Md. He was cared for by the Maryland authorities at this point 
for a while, and then returned by them to West Virginia, arriving at Parkers- 
burg July 31. By the West Virginia authorities he was sent to Pickens, in 
that State, and isolated near that town under care of the State board of health, 
a physician being appointed to care for him. 

The bureau was appealed to from several sources to do something for this 
leper, and in each instance a reply was sent that officially the bureau had no 
power nor responsibility in the matter. However, the matter was taken up 
privately between the Surgeon General, the secretary of the State board of 
health, of Maryland, and the quarantine officer of the port of New York. A 
movement had been started among the Syrians and others benevolently inclined 
for the collection of a fund sufficient to secure transportation back to the land 
of his nativity, to which he was eager to go, believing there he would find a 
cure for his disease. 

Through the efforts of the secretary of the State board of health of Maryland 
and others a sufficient fund was raised, and on being informed to this effect. 
I communicated with the quarantine officer at New York, who endeavored to 
arrange for the transportation of the leper with an attendant on some steamer 
bound for Alexandria, Egypt, from which city the leper could doubtless find 



80 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

his way to Beirut. Before the necessary arrangements could be completed, 
however, death ended the sufferings of this unfortunate person October 2<>. 

The newspapers were full of the hardships encountered by this leper in being 
bandied from place to place, isolated, and an object of aversion wherever he 
went, the spectacle being one discreditable to the country. 

Mr. Danner. This report cites the cases of a number of lepers with 
very unfortunate treatment, including the one discovered at Elkins, 
W. Va., whose death soon followed his experiences of suffering and 
terminated his case. 

One of my friends said to me the other day that I was altogether 
too insistent for a national leprosarium; that if there were approxi- 
mately 500, and perhaps a thousand, lepers in this country, he 
thought I was unnecessarily alarmed and out of order in urging any 
kind of national legislation for the lepers. I told him we were not 
trying to fight a battle with a chance of losing, but that by segre- 
gation leprosy had been stamped out of Great Britain and almost 
out of Norway and greatly reduced in the Philippines. He still 
said, " I think you are too insistent about this question, if there are 
only 500 lepers, or even a thousand, in this country." I said to 
him, "Will you tell me what you would do if your house was on 
fire?" He said, "I would send for the fire department." I said, 
" Suppose the fire had only started, when would you send for the 
fire department? " He said, "Right away." I said, "Why not wait 
until the fire had gotten a good start, then call your fire department, 
so as to show what an efficient fire department you had ? " 

With assurance that segregating the lepers will accomplish within 
our own generation the absolute elimination of leprosy from this 
whole Nation, is it not worth while to do it now ? 

Senator Works. This bill does not provide any means by which 
the Government can compel lepers to submit to the treatment, 
does it? 

The Chairman. No, sir; it does not. 

Senator Works. Do you not think the bill itself ought to provide 
something of that kind, if this sanitarium is to be established — some 
authority given to compel the lepers to go to the sanitarium when 
they are apprehended? 

The Chairman. I was under the impression that that would 
have to come from the local or State authorities. 

Senator Works. No ; I do not think so. 

Mr. Danner. Following the line of what Dr. Dyer said this 
morning, might I give some information secured by correspondence 
with our oriental stations ? 

The Chairman. Yes. 

Mr. Danner. The Mission to Lepers engaged a Mr. W. H. P. 
Anderson, of Boston, 10 years ago to take charge of the second 
largest oriental leper mission asylum in the world. There was no 
law compelling lepers to come into this station. Our mission main- 
tains a large number of these asylums. There are Government asy- 
lums also. It was found after a few years that the mission asylums 
were usually overcrowded, while the Government asvlums usually 
had vacant beds. Investigation of the station supervised by Mr. 
Anderson disclosed the fact that forcing lepers into an asylum was 
sometimes less effective than offering the inducements of sympathy 
and mercv and a chance to ffet well. Since talking with one of the 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 81 

doctors here this morning I have quite reached the conclusion that 
the opportunity for people in this country to get well, to have proper 
treatment, and to have a sympathetic appreciation of their real 
condition, would be so much appreciated that the average person 
with leprosy would not have to be compelled to go into a national 
leprosarium, but would be glad of an opportunity to enter such a 
door of hope. 

Senator Works. That might be if it were confined to a narrow 
territory, but taking the country over I should think there would 
be some question about it. If the National Government has no 
power to compel these people to go to the asylum, if it be established, 
then the Government would have no authority to deal with it at all, 
and the mere appropriation for the sanitarium itself would be be- 
yond the jurisdiction of the Federal Government. 

The Chairman. The question of the constitutional right we will 
have to discuss among ourselves. 

Senator Works. Yes; but that is a matter about which I am in 
some doubt. 

The Chairmax. Yes; we will have to study that. I would like 
to state that I visited John Early, this Washington leper, on Sunday 
last with Dr. Fowler and my assistant secretary, Joseph M. Bault. I 
asked him what he thought of a national home and whether it 
would be used. He seemed perfectly delighted with the idea of 
having one and said he would go to it with the greatest of pleasure: 
that the condition he was now in was "hell, 7 ' although he was not 
complaining in the slightest way of his treatment, for he seemed to 
be as kindly treated as conditions will permit, but it was simply 
horrible, and, to use his own language, it was " hell," and he said 
that he and every other poor leper in the United States, in his judg- 
ment, would be delighted to go to a national home, where they would 
have a great many comforts and at least companionship. I think 
that is worth putting down as the testimony of a man who is him- 
self a leper and a man of some intelligence and who has gone 
through terrible suffering. 

Senator Works. Mr. Danner may be entirely right about that 
matter. I imagine a great many of them would go voluntarily and 
gladly in their condition, but still I think the authority should be 
provided to compel those who may not be willing to go to do so. 
You would probably have some of them who would not go willingly. 

Mr. Danner. I think that the point is well taken and that if it is 
possible to have authority it should be had, and then use all the per- 
suasion that is possible. 

Senator Works. Oh, no ; I do not think force should be used ex- 
cept as a very last resort. 

The Chairmax. If I understood Dr. Dyer correctly, in Louisiana 
they are compelled to go there. 

Dr. Dyer. Twenty per cent are compelled to go, and 80 per cent 
go voluntarily. 

The Chairmax. But the authoritv exists in the law to force them 
to go? 

Dr. Dyer. Yes: exactly as an insane person. They are brought 
before a judge in chambers or in his court. 

The Chairmax. And the judge orders them to go there? 

Dr. Dyer. Yes. 



82 TKEATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. So they have the same machinery there as for 
committing an insane person? 

Senator Works. I am not sure but what this bill does give that 
authority. Look at section three. 

The Chairman. That is after they get there. That is the way I 
construe that. 

Senator Works. No; the apprehension, I suppose. 

The Chairman. Perhaps that would apply to any part of the 
United States. That is a question we can study later and act upon. 
Dr. Fulton, will you please come forward. You are the secretary of 
the State Board of Health of Maryland? 

Dr. Fulton. Yes, sir. 

STATEMENT OF DR. JOHN S. FULTON, SECRETARY OF THE STATE 
BOARD OF HEALTH OF MARYLAND. 

The Chairman. Doctor, will you please give us your impressions 
of this subject and state first what experience 3 r ou have had with 
leprosy ? 

Dr. Fulton. I have had no important experience with leprosy. I 
am familiar with this legislation, however, during some 16 or 18 
years, when it has been either before Congress or in process of prep- 
aration, and I have frequently been present when the subject was 
under discussion among the health officials of the country. 

I come from a State which has no Leprosy, so far as we are aware. 
There have been three cases of leprosy in the State of Maryland 
within the last 16 years, and their history is the best illustration I 
can give of the necessity for such legislation as this bill contem- 
plates. 

The first of these cases was a citizen of Pennsylvania — M. S. 
She lived in Pittsburgh or Pennsylvania and came to Baltimore in 
189T or 1898. Having some skin disease about which physicians were 
puzzled, she went to the Johns Hopkins Hospital to find out what 
was the matter with her. Her trouble was recognized as leprosy, 
and due notice was given to the health authorities. 

The city authorities had an old brick building on the abandoned 
quarantine grounds. This building was renovated and made ready 
for the care of M. S., when an improvement association prayed the 
•courts to enjoin the city from using this building or the grounds for 
tthe care of a leper. A preliminary injunction was granted and after 
trial the injunction was made permanent. 

Meanwhile Mrs. S. remained in Johns Hopkins Hospital. If the 
liospital authorities had allowed M. S. to go, it is probable that the 
city authorities would have taken no notice of her departure. The 
hospital authorities elected to keep her, however, and she remained 
there for several years. 

The city incurred no expenses for her maintenance; she was sup- 
ported wholly by the hospital; nobody went to see her but. the 
medical men and the students who wished to study leprosy, and the 
nurses; she never put her foot on grass, nor saw more sky than you 
can see through these windows, and there she died. 

The next case of leprosy was one of those mentioned a few minutes 
ago by Mr. Danner. He was a Syrian about 22 years old, named 
M. R., who became notorious throughout the country under the name 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 83 

of Rossett. He achieved this fame in about 2 weeks, and survived 
about 12 weeks. He came to my attention in June, 1906. R. had 
lived in Maine. For a while he was a peddler, and for a year he 
worked in a cotton mill at Waterville, Me. Subsequently he lived in 
Michigan City, Ind., in Uniontown, Pa., Enterprise, W. Va., Clarks- 
burg, Philippi, and Elkins, W. Va. He consulted many physicians 
about a chronic skin disease. In June, 1906, he consulted Dr. W. W. 
Golden, of Elkins, who recognized tubercular leprosy. Several phy- 
sicians saw the case and were greatly interested. The case was of 
such interest that R. was taken to the meeting of the Medical Society 
of Barbour, Randolph, and Tucker Counties on July 2, to illustrate 
a clinic on leprosy, probably the first clinic of the kind ever held in 
West Virginia. Subsequently a sum of money was raised to send 
R. and his brother to New York. It does not appear that this was 
done officially, or with any attempt at secrecy. Quite the contrary. 
R. and his brother went as ordinary passengers on an accommodation 
train. According to accounts it was a great journey. The news 
traveled faster than the train. It is said that people came to the 
stations to see the leper, and at several stations physicians boarded 
the train and examined the man. The "big noise" reached Cum- 
berland in time to stir up the authorities. In time also for R. and 
his brother to be warned that they would not be allowed to enter 
Maryland. They left the train probably before the train reached the 
Maryland line. He and his bother eluded the authorities, which was 
perhaps not difficult, for it was night when the train reached Cum- 
berland. The brothers were separated, however, and R. boarded a 
Baltimore & Ohio freight train for New York. He was penniless, 
for his lost brother carried the funds. 

Next day the Maryland authorities learned from the Pennsyl- 
vania authorities that the car carrying R. had been detached and 
coupled to a westbound freight train. The Baltimore authorities 
forbade the railroad to bring that car to Baltimore. Accordingly 
the car was left on a siding at a lonely station, Golden Ring, Balti- 
more County, and there we found him. 

Under the conditions of Maryland law, the only place where a 
leper can be kept is the spot where he is found, and the cost of his 
maintenance is a charge upon the local authorities; in this case the 
county commissioners of Baltimore. 

On this spot R. became famous from end to end of the country. 
Newspaper notoriety was- the chief obstacle to the final disposition of 
the case by the Maryland authorities. 

We broke most of the laws of decency _ and humanity in handling 
this leper. Nobody was consulted or informed. Everj^body was 
encouraged to look in some wrong direction. R. himself was obe- 
dient as a dog, and as trustful. He was carried back to West Vir- 
ginia on the Cincinnati express as an ordinary passenger, disguised 
very simply by means of an accordion. Every member of the State 
Board of Health of West Virginia was informed by wire in time to 
have taken R. in charge at any point from Rowlesburg, 6 miles across 
the State line, where a member of the State board of health lived, to 
Clarksburg, which was R.'s destination, and the home of the presi- 
dent of the board. We also sent telegrams to all of the surrounding 
States informing them that we had returned R. to West Virginia. 
At the time we believed that West Virginia had deliberately tiled to 



84 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

shift the responsibility to some other State and might do so again. 
In this, of course, we were mistaken. 

We applied to the United States Public Health Service for re- 
lief, and wrote to the West Virginia authorities offering to co- 
operate in an effort to send R. back to this native country, which 
would have been the thing he most desired. The United States Pub- 
lic Health Service could have deported him, and the arrangements 
were about complete when R. died on a mountain side not far from 
where his journey began. 

To me this is a harrowing story. No one of humane feelings 
could be otherwise than in contempt of himself for having recourse 
to such methods in such a situation. 

The Chairman. What was the length of time from his leaving 
West Virginia, in the first instance, until he died? 

Dr. Fulton. He was sidetracked at Golden Ring on July 22, I 
think, and was back in West Virginia on August 1. He died on 
October 19. 

The Chairman. He died in West Virginia ? 

Dr. Fulton. Yes: in West Virginia. 

The Chairman. Do you know what was done with him in West 
Virginia, Doctor? 

Dr. Fulton. He was put off the train at Parkersburg and he was 
taken up to Pickens, in Randolph County, where a cabin on the 
mountain side was devoted to his use. I suppose they treated him 
all right; and if he had lived six weeks longer the Surgeon General 
would have put him on a ship and returned him to his own country. 

The last of the cases known to me was that of a young Italian 
woman named M. She had been living in Baltimore three or four 
years and possibly developed the disease in Baltimore, though it 
"was said that she had some skin trouble when she arrived at the 
port of New York. 

She went to Johns Hopkins Dispensary. Her disease was recog- 
nized, and she became a regular dispensary patient. The health 
authorities were aware of the facts. She could have continued as 
a dispensary patient but for the action of her neighbors. 

The case soon became known through the newspapers. The 
health authorities were obliged to provide for her custody. A little 
house was built for her at the present quarantine station, and she 
lived there about 13 months. Her husband then secured, through 
the courts, her release into his care, on condition that he would take 
her out of Maryland. This occurred on July 21, 1911. They could 
have easily left Maryland, and probably did. At all events, we know 
no more about Mrs. M., and we believe that there is no leprosy in 
Mandand. 

It would seem absurd for the State to support a leprosarium, 
when we have no lepers and do not want any. The argument for 
a national leprosarium is the humane argument. Everywhere i 
leper is not only an object of fear, but also of curiosity. Lepers can 
only find out how inhospitable and how inhumane we are by travel- 
ing, as so many have done, from State to State, seeking rest and 
finding none. 

At the conclusion of the R. incident, I said in a Baltimore news- 
paper that our behavior in th Q R. case was. from the scientific stand- 
point, absurd, and from the viewpoint of humaneness, contemptible. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 85 

The Chairman. How do you feel, Doctor, toward the passage of 
such a bill as this, and how does the profession in your State feel in 
regard to it? 

Dr. Fulton. I am very much in favor of the passage of a bill of 
this sort. I do not think the profession in my State is very sensi- 
tive on the subject. Their experience is not such as to arouse them. 
At the Johns Hopkins Hospital, however, you would find a vigorous 
sentiment in favor of this legislation. They had to carry the whole 
load — service, sympathy, and cost — in the case of M. S. 

The Chairman. Have you any other suggestion to make, Doctor? 

Dr. Fulton. No; I have not. 

The Chairman. We are very much obliged to you. Doctor. 

Dr. Fulton. Not at all. 

The Chairman. Dr. Hoffman, we will hear 3^011 now. 

STATEMENT OF FREDERICK L. HOFFMAN, LL. D.. STATISTICIAN, 
THE PRUDENTIAL INSURANCE CO. OF AMERICA, NEWARK. 
N. J. 

The Chairman. Doctor, I will ask you to please discuss this ques- 
tion in your own way. 

Dr. Hoffman. I have taken note of what has already been said in 
evidence, and I will try to answer some of the questions that have 
beer raised, particularly by Senator Works. At the outset, however, 
I would like to explain my own interest in this matter, which ex- 
tends over about 20 years, and which has included visits to the leper 
settlements at Molokai and in Louisiana, as well as to the isolation 
hospital at San Francisco, where some 15 cases are being taken care 
of. I have also seen isolated cases of leprosy, including the two 
patients for some time under confinement here in Washington. I 
have, therefore, the advantage of a fairly extended personal knowl- 
edge of actual cases, but, in addition thereto, I have quite extensively 
considered the statistics of leprosy throughout the United States and 
the remainder of the civilized world, with the result that I am abso- 
lutely convinced of the gradual increase of leprosy in this country 
in the absence of effective segregation. And I desire to impress upon 
you, Mr. Chairman, and upon your committee, the profound convic- 
tion that leprosy in America is a much more serious menace to the 
public than is generally assumed to be the case. 

By way of illustration of the ever-present menace of leprosy, I 
would submit for inclusion in the record the following case reported 
in the New York Sun of this morning from Brooklyn, N. Y. : 

Tillie Davis, 18 years old, who died on Saturday in the Kings County Hospi- 
tal and was buried yesterday in Mount Sinai Cemetery, was a victim of leprosy, 
according to the coroner's certificate. She was admitted to the hospital 10 
months ago. About a year prior to that she came from Key West, where her 
parents live, to join a sister in Brooklyn. 

Deputy Supt. Price of the hospital said that when the girl was taken to the 
hospital'the diagnosis showed that she was suffering from leprosy and internal 
ulcer. 

" We isolated her," Mr. Price said, " as much as possible. Men suffering 
from leprosy are sent to an isolated section of Blackwells Island, but no pro- 
vision is made for women. Her condition did not develop sufficiently to threaten 
inoculation of other patients." 



86 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Only two weeks ago, under date of February 1, 1916, the New 
York Sun published the following account of a case of leprosy dis- 
covered in Jersey City : 

Magdelina McLean, 17 years old, was taken from her home at 930 Westside 
Avenue, Jersey City, yesterday to the Hudson County Contagious Diseases 
Colony at Snake Hill, a victim of leprosy. The health authorities had just 
received their first knowledge of the case, although the girl had been suffering 
from the disease for five years. 

When the girl's parents learned the nature of the disease they placed one 
room in their apartment under quarantine. Care was taken to see that nobody 
touched anything with which the girl's hands might have come in contact, and 
other members of the family were saved from contracting the disease. The 
girl was a pupil in public school No. 23 and a member of St. John's Episcopal 
Sunday School when stricken. 

Physicians say that her case is too far advanced to make a cure possible. 

Cases of this nature are sufficiently common to demand considera- 
tion. The history of the cases found at large is almost invariably to 
the effect that the disease was not recognized in its early stages, and 
that therefore there had been more or less promiscuous contact with 
the public, at the serious risk of infection. There are reasons, there- 
fore, for believing that there are many more foci of leprosy in this 
country than we have positive knowledge of. Almost invariably 
when such cases are discovered proof is forthcoming of some ante- 
cedent connection with a case of leprosy or exposure to the disease 
in some focus of infection, chiefly the Philippines, Hawaii, Cuba, 
the West Indies, etc. 

This bill, or rather the principle of this bill, has the official in- 
dorsement of the American Dermatological Association, the Ameri- 
can Medical Association, the American Academy of Medicine, and 
the Thirteenth Annual Conference of State and Territorial Health 
Officers with the United States Public Health Service. With your 
permission, I shall read to you a resolution which I introduced at the 
last meeting of the conference and which, on motion of Dr. Dowling. 
State health officer of Louisiana, seconded by Dr. Hurty, the health 
officer of Indiana, was unanimously adopted: 

Whereas leprosy exists or occurs in practically every State and Territory of 

the United States ; and 
Whereas there are only three public leprosaria under State control in the 

United States; and 
Whereas there is no concerted movement on foot for the Federal control of 

leprosy : Therefore be it 

Resolved, That this conference regards leprosy as a national problem and 
recommends to Congress the establishment of national leper homes in various 
parts of the United States in order that lepers may be effectively isolated and 
receive humanitarian treatment and that the spread of the disease may be 
effectively checked. 

I subsequently had occasion to present a similar resolution at the 
meeting of the American Academy of Medicine, held in San Fran- 
cisco, which was also unanimously adopted. Before presenting my 
resolution I had entered into correspondence with nearly every State 
health officer in this country, and I have here with me the letters 
received in reply to a circular request for information, including a 
number of letters from health officers of large municipalities. With 
a single exception, all of the letters are in favor of the principle of 
this bill, as incorporated in my question, "Are you in favor of a 
national leprosarium to provide for the adequate treatment and 
care of at least such lepers as are apprehended by the authorities 






TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 87 

while in interstate transit and which are probably the only cases 
which at the present time can be properly taken care of by the Gov- 
ernment ? " 

The Chairman. Did all of your correspondents reply to your in- 
quiry ? 

Dr. Hoffman. Practically all were good enough to do so. A few 
made no reply, probably because no leprosy existed in the State or 
municipality concerned. In summarizing the results I find that 39 
State health officers replied in the affirmative and only 1 — Cali- 
fornia — replied in the negative. That health officer, however, is no 
longer connected with the California State Board of Health. What 
the attitude of the present officer is I do not know. 

The Chairman. These are the replies of the health officers of 39 
States? 

Dr. Hoffman. Yes ; the official health officers of 39 States, without 
qualification, indorsed the principle of this bill as set forth in the 
question contained in my circular letter of inquiry. 

The Chairman. Was there any objection urged to the bill ? 

Dr. Hoffman. No specific objection was raised by anyone further 
than that the State health officer of California in office at the time 
simply replied in the negative. With your permission, I would like 
to incorporate in the record the following extracts from some of the 
letters received. 

The secretary of the State Board of Health of Illinois replies : 

" This board favors the establishment of an institution in which proper care 
of lepers may be taken. As an instance in which such an institution would 
have been of practical service, I would respectfully recall the experience of the 
city of Highland Park, 111." 

Dr. Hurty, State health officer of Indiana, writes as follows : 

" I believe t"hat segregation in all cases is advisable. Lepers should not be at 
large in the community. I favor a national leprosarium. Leprosy is a 
national problem, on account of its unusual features and the history of the 
disease." 

The State health commissioner of Oklahoma writes as follows : 

" Two cases of leprosy were reported to me and both were negroes. Both had 
come from New Orleans and both had spent several years in Mexico. One was 
discovered first in the State penitentiary, and he subsequently escaped. The 
guards were very much afraid of him. The other was a pauper on a poor 
farm, where he died. I am confident that there are many more lepers than 
we have any knowledge of. The lack of proper and humane places where they 
can be cared for causes them and their families to keep the knowledge of 
their trouble to themselves. The Government should provide a place for these 
unfortunates. There are too few in most of our States for the State to recog- 
nize its responsibility in leprosy. The United States Government can care for 
all of these and should provide a hospital for them, and that at once." 

The director of Public Health and Charities of Philadelphia states 
that he favors segregation for all lepers, and he adds : 

" The manner in which lepers are shunned is not a credit to an intelligent 
people. It would be ideal to have a national leprosarium ; but it probably is 
not feasible on account of functions required of each State." 

The secretary of the State Board of Health of Utah writes that he 
is " emphatically in favor of a national leprosarium." 

The acting commissioner of health of the city of Seattle replies : 

We think there should be a national leprosarium, and we are also of the 
opinion that arrangements should be made whereby the State and city authori- 



88 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

ties could transfer all cases of leprosy to this institution. The writer is more 
or less familiar with leprosy problems, having lived in the Hawaiian Islands 
three and a half years. 

The secretary of the State Board of Health of Wisconsin replies : 

We are very much in favor of a national leprosarium, as it is always a 
difficult matter to properly segregate and provide for the treatment of unknown 
cases when discovered. As a result there is a constant temptation to either 
deport the cases or allow them to leave voluntarily, so that they will pass out 
of the jurisdiction where found. This we believe is very undesirable. 

I have also here a letter from the secretary to the commissioner 
of health of the city of New York, who, in answer to a letter of 
mine elated February 9, 1916, writes: 

The records of this department show -!4 cases of leprosy in this city at the 
present time. 

The secretary refers to the weekly bulletin of the department for 
October 30, 1915, in which is stated the official attitude of the depart- 
ment with reference to leprosy cases, it being held that " patients 
with suitable home surroundings, and where hygienic precautions 
are preserved, may be permitted to remain at their homes." Fur- 
thermore, it is said that " it is an accepted fact among physicians 
that the danger of transmitting leprosy in this climate is small, 
though there appears to be some danger in the South. When the 
leper has no open lesions and no discharge from the nose it is safe 
for him to be at large. A leper with open lesions, if careful and if 
home conditions are suitable, may be safely segregated in the home." 

I w r ould respectfully suggest, Mr. Chairman, that you request the 
official opinion of the Surgeon General of the United States Public 
Health Service as to whether these general and apparently extremely 
superficial precautions afford adequate protection to the public. I 
may be permitted to add in this connection that, so far as known, 
there is no direct relation between climate and leprosy occurrence, 
since the disease is met with in all climates, from Iceland to the 
Tropics. 

Unless there is effective segregation and otherwise adequate provi- 
sion for the care of lepers, it is extremely difficult, if not impossible. 
to ascertain the number of lepers in the community. According to 
the replies received from the health officers referred to, there are 
about 150 lepers knoAvn to be in the United States at the present 
time ; but there is no question of doubt, in my own mind, that there 
are certainly three times as many lepers in this country, if not more. 

Under date of May 15, 1915, or less than a year ago, the Lancet 
Clinic, an important medical paper contained the statement that 
" Eighty lepers walk the streets of Chicago daily." This statement 
was made by Dr. George A. Zeller, a member of the Illinois State 
Board of Administration, while in Chicago for the purpose of exam- 
ining Angelo Lunardi. a leper found at Highland Park. 

In reply to an inquiry of mine to the commissioner of health of 
Chicago, Dr. Bertson was good enough to wire me as follows: " Skin 
specialists of Chicago concur in Dr. Zeller's statement. Three case9 
of leprosy reported to department of health in 1915. All three 
isolated." 

In the absence of adequate provision for the humane care of lepers 
under suitable conditions, many leprosy cases are unquestionably 
hidden and kept out of public notice, as best illustrated in the 



TREATMENT OF PERSON'S AFFLICTED WITH LEPROSY. 89 

Jersey City case, previously referred to. During recent years I 
have collected quite a number of individual cases, emphasizing the 
inhuman and often brutal and uncivilized treatment of lepers in this 
country, who are apprehended, transported, and isolated, frequently 
under most trying conditions. 

The Chairman. Could you give us just a few of these cases? 

Dr. Hoffman. I am pleased to say that I have the records with 
me, and shall be very glad to do so. 

Senator Works. That, I presume, results more from the fear of 
contagion. 

Dr. Hoffman. It is not so much the fear of contagion as it is the 
ignorance of the general public regarding the disease and the help- 
lessness of the communities concerned as regards the best course to 
pursue. Where these isolated cases occur the community is, as a 
general rule, entirely unprovided with suitable facilities for treat- 
ment and care, and absolute isolation in the case of a single leper is 
Avithout doubt an act of inhumanity in itself and a method precluding 
proper treatment, with the possible chance of an arrest of the disease 
and the more remote possibility of a cure. 

Through the courtesy of the board of health of the city of San 
Francisco, I have obtained a copy of the entire official record of the 
notorious Grable case, than which there is no more conclusive evi- 
dence to be had in favor of this bill and the principle of a Federal 
leprosarium. E. E. Grable originally came from Pocatello, Idaho, 
on June 30, 1911. direct to San Francisco with an obvious case of 
leprosy, diagnosed by Dr. Blue on the first examination. He was 
admitted to the isolation hospital where the San Francisco lepers 
are cared for, and he thereupon became a charge upon the com- 
munity, in no wise responsible for his condition, the disease having 
been contracted in the Philippines. All efforts to return him to 
Idaho proved unsuccessful, and equally so was an effort to have him 
cared for at the Federal quarantine station at Port Townsend, Wash. 
Grable absconded from the San Francisco isolation hospital in De- 
cember, 1912, but in May, 1913, he applied again for admission, hav- 
ing in the meantime worked at his old occupation of railroading. 
Grable absconded again on September 9, 1913, and he was next heard 
from at St. Louis. Subsequently he appeared at Washington, D. C, 
where he was cared for for some time, absconding again to return to 
St. Louis, and subsequently to be cared for at Koch, Mo., where he 
is at the present time, according to an official statement by the health 
officer of the District of Columbia. Since his first apprehension in 
San Francisco, Grable had traveled extensively, apparently on a mem- 
bership card of a railway union, visiting many other places — Salt 
Lake City, St. Louis, and points in Canada. 

Senator Works. How did he get away from San Francisco? Did 
he escape? 

Dr. Hoffman. Yes; he escaped, or more properly, perhaps, he 
absconded. The conditions of segregation at San Francisco are, 
fortunately, such as to have the least semblance to imprisonment or 
forcible detention. The hospital is surrounded by a wall, but escape 
would not be very difficult, in an emergency. It is the general ex- 
perience at well-conducted leper settlements that few of the inmates 
even desire to leave. At the San Francisco isolation hospital lepers 



90 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



are cared for in a humane manner and without risk to the community, 
although the institution is located within the city limits. There is 
no outcry against their care and detention such as has been common 
in the case of communities not familiar with the urgency of effective 
segregation. Xothing is left undone to make the conditions of exist- 
ence as bearable and even as pleasant as possible. I can not speak too 
highly of the excellent work which is being done by Dr. A. A. O'NeilK 
the physician in charge. Each leper is allowed a room to himself and 
he has absolute freedom to do what he pleases. All who are able are 
more or less occupied at light labor suitable to their condition, but of 
their own free choice. 

Senator Works. Do you know how many lepers there are at San 
Francisco at the present time? 

Dr. Hoffman. Yes, Senator; I have here a special return which I 
would like to introduce in evidence, furnished through the courtesy 
of Dr. O'Neill, showing that at the present time 15 lepers are being 
cared for, including 3 ex-soldiers with former experience in the 
Philippines. The list is as follows, but in place of the name I give 
only the initials: 

List of leper patients at isolation hospital, San Francisco, Cal. 



Initials. 


Age. 


Place of birth. 


Sex. 


Type of 
disease. 


Prob- 
able 
dura- 
tion. 


Admission to 
hospital. 


Last residence. 


0. T 


12 
57 

34 
40 
30 
35 
35 
41 
62 
29 
57 
60 
59 
48 
40 


Manila, P. I... 
Troy, Kans . . . 

Greece 

Mexico 


Male.. 
...do.. 

...do.. 
...do.. 
...do.. 


Mixed 

Tubercular 

.....do 


Years. 
2 
5 

5 

27 
7 
7 
10 
10 
12 
(?) 

18 
(?) 
(?) 
(?) 
1 


Nov. 5,1915 
Dec. 15,1915 

Dec. 16,1912 
Mar. 2,1890 
June 7,1911 
Apr. 27,1912 
June 24,1908 
Apr. 25,190S 
June 24,1908 
May 15,1911 
Apr. —,1896 
— , 1897 
Mar. 2, 1903 
Oct. 2,1902 
Feb. 12,1916 


Valleio, Cal. 
Soldier's Home, 
Yountvilje, Cal. 


F. W. LA... 
M V 


P. P 


Do. 


D. R 


Tubercular 

do 

do 

do 

do 


Do. 


W.L 

J. P 


Honolulu, H.T 
Hilo,H. T.... 

Greece 

Maryland 


...do.. 
...do.. 
...do.. 
...do.. 
.. do 


Do. 
Do. 


P. P 


Do. 


S.J. (negro)*. 
F. S 


Berkeley, Cal. 


H. G 


do 

do 

do 

do 

Ohio 


...do.. 
...do.. 
...do.. 
...do.. 
...do.. 


do 

do 

Tubercular 

do 

do 


Do. 


L.H 


Do. 


Y. F 


Do. 


F. G 


Do. 


E.M.N.*.... 


Norwalk, Ohio. 



* Those marked thus (*) are ex-soldiers, I have examined four others.— Dr. O'Neill. 

I have also here a statement from the secretary of the State Board of 
Health of California to the effect that there are about 30 known cases 
of leprosy in the State. 

The Chairman. Will you not describe the method of segregation 
followed at San Francisco, of which you speak so highly, a little more 
in detail? 

Dr. Hoffman. The point, Senator, is this: That the practical ques- 
tion which will confront your committee in connection with this bill 
is, Where is the Federal leprosarium to be located? You will every- 
where meet with a hue and cry that nobody wants these lepers; that 
nobody wants such a colony on account of the possible risk to the 
community. As a matter of fact there is no risk to the surrounding 
community in the case of a leper settlement, under proper conditions 
of segregation. The Molokai settlement occupies only a small area 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 91 

of the island of Molokai, which is extensively cultivated for planta- 
tion purposes, and where there is no record of infection having spread 
from the settlement to the community. The reason why the San 
Francisco institution is so particularly deserving of consideration 
is that the same is located within the city limits, with reasonably 
satisfactory conditions of treatment and care, excepting, perhaps, 
that more help might be provided to relieve Dr. O'Neill of a heavy 
burden, which, however, is cheerfully borne. There is no evidence 
that during the years since the settlement has been in existence any 
infection whatsoever has been spread to the adjoining neighborhood. 
. There is sufficient space for some of the lepers to cultivate a small 
garden. One Chinese leper, although in a fairly advanced stage of 
the disease, has built himself an artificial fish pond. Another leper 
has done excellent work in the raising of vegetables and fruits, in 
conformity to advanced principles of intensive agriculture. A 
Japanese leper is an expert carpenter and he has furnished his room 
in a most attractive manner. There is entire harmony among the 
lepers and each one helps the other as far as is practicable. One of 
the lepers is entirely blind, but he still performs a considerable 
amount of useful work. 

You will note by reference to the list that five of the patients under 
treatment at the present time were born in China, three were born 
in Greece, two in Hawaii, one in Mexico, one in the Philippines, and 
three in the United States, respectively, Kansas, Maryland, and Ohio. 
Not a single one of the patients was born in California ; nearly all of 
them have a record of previous exposure in a known foci of infection. 

The Massachusetts settlement is on Penikese Island, in the very 
heart of the most attractive summer resort region in New England. 
I have here a map which shows exactly where the island is located, 
so that you can judge for yourselves. It is in close proximity to 
Cape Cod and Marthas Vineyard. 

Senator Works. Whereabouts is the leprosarium in San Francisco 
located ? 

Dr. Hoffman. It is at the Isolation Hospital, right near the out- 
skirts of the city, at Army and De Haro Streets. 

Now, if you can establish such an ideal colony as Massachusetts 
has in the heart of a summer resort region without detriment to the 
community and without risk of infection; and if you can establish 
such an excellent institution as San Francisco has reason to be proud 
of within the city limits, and without any practical difficulty, it is 
self-evident that when the question comes up as to where a Federal 
leprosarium should be located, it will not be so difficult to find a suit- 
able location if the public is rationally and intelligently informed as 
regards the facts, derived from actual experience. 

Senator Works. I suggested this morning that the Government 
might take over one or the other of the leprosariums that have 
already been established, which would, of course, create a great deal 
less friction than an effort to establish a new one. 

The Chairman. Dr. Hoffman, do I understand that San Francisco 
has a sanitarium for leprosy, or is it merely one department of its 
big city hospital? 

Dr. Hoffman. The best way I can describe the situation is that an 
adjoining yard of sufficient area has been fenced off from the isola- 



92 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

tion hospital. Access to the institution is through the isolation hos- 
pital; but, as said before, the physician of the one is also in charge 
of the other institution. The lepers live in two large houses espe- 
cially built for the purpose, each one having a room to himself. 
There is no connection between the isolation hospital and the great 
modern city and county hospital of San Francisco, which, in fact, 
is quite a distance from the leper settlement. The lepers have all 
the freedom they are properly entitled to without being a menace 
to the community, and they are, in their way, I am glad to say, happy 
and contented. 

In contrast, permit me to direct your attention to the Early case 
in this city, where a single leper is isolated under only fairly satis- 
factory conditions. Even a leper remains human and desires com- 
pany. The best way is to bring these afflicted people together in a 
settlement where they can be properly treated and where they feel 
that they are not looked upon as outcasts or prisoners. 

At Molokai there are some six hundred and odd lepers, who constitute 
a happy and contented community. They have about all that goes to 
make life worth living under the trying conditions of their unhappy 
existence; they have, as far as practicable, their own houses, and 
many of them have their own families with them. The community 
has all the advantages of village life, including churches of different 
denominations, a well-equipped store, a baseball ground, a moving- 
picture show, etc. I can say in the light of my own experience that I 
never felt nearer to the attainment of peace on earth than I did among 
the lepers at Molokai. My personal investigations at Molokai, at San 
Francisco, and in Louisiana have profoundly impressed upon me the 
duty of a persistent effort in behalf of these most unfortunate and ab- 
solutely helpless victims of a peculiarly loathsome and practically 
hopeless disease. No words of mine can give expression to my own 
sorrow for these people ; but in the light of my personal knowledge I 
can not but feel intensely the additional sorrow and suffering need- 
lessly forced upon the helpless individual who suddenly and b^v no 
fault of his own finds himself the victim of leprosy in a State where 
he may be the only one of his kind. I believe that the Nation OAves it 
to itself and to the cause of a broader civilization that it shall leave 
nothing undone to provide adequately and humanely for these unfor- 
tunates who. under present conditions, are often inhumanly treated. 

Most of the lepers in Hawaii go to Molokai of their own free will 
and accord. They go with the understanding that they will bo 
humanely and effectively treated by skillful physicians and nursed. 
if necessary, by those qualified to do so. Leprosy is a peculiar dis- 
ease, and there are not many physicians who know how to diagnose 
and treat it. A leper is, therefore, infinitely better off in a lepro- 
sarium, such as the institutions in existence in Louisiana or San 
Francisco or on Penikese Island, where the physicians in charge are 
thoroughly familiar with the disease and not apprehensive of the 
risk of infection. I desire to put on record. Mr. Chairman, my 
conviction that what is being done in these institutions for the most 
afflicted of human beings reflects the finest traits of the American 
people and their highest achievement in philanthropy and humanity. 
Not much more could be done for the lepers if twice the amount of 
money were spent ; but more unquestionably could be done to provide 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 93 

adequately for the needs of those in charge of these institutions. 
Lepers require a considerable amount of medical care and nursing. 
Certainly at Molokai and at the settlement, in Louisiana the burden 
which falls upon those in charge is, indeed, a very heavy one. Many 
of the lepers are blind and otherwise helpless. The Mother Superior 
in charge of the nurses at Molokai has been at the settlement for 
more than 20 years. The sisters perform the most menial service in 
the most efficient and uncomplaining way. Not a single case of lep- 
rosy infection has occurred among them. The Catholic sisters at 
the settlement in Louisiana perform a similar Christian and humane 
service under equally trying conditions. 

The same conclusion applies to the sisters in charge of the Lazaretto 
at Tracadie, New Brunswick. There is, however, no exceptional 
martyrdom about this service, and the seclusion and isolation is self- 
imposed. The history of Christian service, however, affords no finer 
illustration of heroic self-secrifice than the work rendered by the 
physicians in charge and the nursing sisters and other lay helpers 
ministering to the needs of the most afflicted under the trying condi- 
tions of settlement life. 

The Chairman. I wanted to ask you, before you get entirely away 
from the subject of California, whether the State maintains the 
leprosarium there or the city of San Francisco ? 

Dr. Hoffman. The entire cost of the maintenance of the leper set- 
tlement at San Francisco, so far as I know, is paid for by the city of 
San Francisco, under the direction and supervision of the city board 
of health. 

The Chairman. Does the settlement take lepers from all over the 
State? 

Dr. Hoffman. No, Senator; only, so far as I know, those who are 
apprehended within the city limits of San Francisco. 

The Chairman. Then there is no State leprosarium in California ? 

Dr. Hoffman. No. Senator; there are no State institutions of this 
kind in California. Outside of San Francisco, there is a small leper 
settlement in or near Los Angeles, which, however, I had no oppor- 
tunity to visit. There are probably six or seven patients there, but I 
understand they are adequately and suitably provided for. There 
are also one or two cases, I believe, at or near San Diego. 

For the convenience of your committee, Mr. Chairman, I have pre- 
pared a list of leper settlements throughout the world for the pur- 
pose of making clear my point of view that in practically all other 
civilized countries the care of lepers is a matter of Government con- 
cern and in precise conformity to the principle of the bill under con- 
sideration providing for the establishment of a Federal leprosarium. 

The Chairman. If there is no objection, we will have this list made 
a part of the testimony. 

(The list referred to was subsequently submitted, and is here 
printed in full, as follows:) 

LIST OF LEPER SETTLEMENTS OR COLONIES THROUGHOUT THE WORLD (PROBABLY 
INCOMPLETE). 

Antigua. — Leper Asylum on Rat Island, harbor of St. Johns. 
Australian Commonwealth. — Leper Lazaret, Little Bay, New South Wales; 
Leper Lazaret, Peel Island, near Brisbane, Queensland; Leper Lazaret, Day- 

33993°— S. Kept. 306, 64-1 7 



94 TREATMENT OP PEESONS APFLICTED WITH LEPEOSY. 

man Island, Torres Straits, Queensland; Leper Lazaret, Mud Island, Northern 
Territory. 

Bahama, Islands. — Leper Infirmary, Nassau. 

Barbados. — Leper Lazaretto (121 inmates). 

Brazil. — Hospital dos Lazaros, Rio de Janeiro. 

British Guiana. — Mahaica Leper Asylum (3S7 inmates). 

British North Borneo. — Segregation camps for lepers, Kapuan Island ; leper 
settlement at Berhala. 

Canada. — Leper Lazaretto, Tracadie, New Brunswick (14 inmates) ; Leper 
Asylum, Vancouver, British Columbia. 

Ceylon. — Leper Asylum near Colombo, Hendala (376 inmates) ; leper colony, 
island of Mantivu, Batticaloa. 

China. — Leper Asylum, Canton (300 inmates) ; Leper Asylum, Hokchiang, 
south of Foochow (100 inmates); Leper Asylum, Foochow ; Leper Asylum 
Kucheng, Fuh Kien Province ; Leper Asylum, Lake Home, Hangchow ; Leper 
Asylum, Siao Kan, Hankow; Leper Home, Tunkun, Quantung Province (140 
inmates). 

Corca. — Fusan Leper Asylum, Fusan. 

Costa Rica. — Hospital de Loprosos, San Jose (63 inmates). 

Cuba. — San Lazaro Hospital for Lepers, Habana. 

Cyprus. — Leper farm, near Nicosia (97 inmates). 

Danish West Indies.— Leper Hospital, St. Croix. 

Dutch Guiana (Surinam). — Leper colony, Bethesda (Moravian mission); 
leper colony, Groot Chatillon (Government). 

Egypt.- — Hospital des Lepreux, Cairo. 

Federated Malay States. — Leper Asylum, Pulau Bangkor Laut, Perak, for 
Malays and Javanese (62 inmates) ; Leper Asylum, Selangor (36S inmates). 

Fiji Islands. — Leper Asylum, Suva. 

Finland. — Leprasjukhus, Tavastehus liin (Government institution, 25 In- 
mates). 

French West Indies. — Hospital des Lepreux, island of La Desirade. 

Germanjj. — Lepra Heim, Memel, East Prussia (20 inmates). 

Greece. — Leper Asylum of Samos. 

Guam. — Leper colony. 

Hawaii. — Kalihi Leper Hospital, Honolulu (30 inmates) ; the Molokai settle- 
ment (638 inmates). 

Iceland. — Leper Asylum, Reykjavik (51 inmates). 

India. — Ahmedabad, Kagrapeth Leper Asylum; Allahabad Leper Asylum, 
United Provinces ; E. F. Allbless Leper Home at Trombay ; Alleppey Leper 
Asylum, Native State of Travancore; Almora Leper Asylum, Province of Ku- 
maon (100 inmates) ; Ambala Leper Asylum, Punjab (20 inmates) ; Ankai 
Leper Asylum, Lower Burma; Asansol " Christaram " Leper Asylum for 
Homeless Lepers, Bengal : Baba Lakban Leper Asylum, Punjab ; Baidyanath 
Leper Asylum, Bengal ; Bankura Leper Asylum, Bengal ; Bbagalpur Leper Asylum, 
North Bengal ; Calcutta Leper Asylum, Bengal ; Calicut Leper Asylum, Madras 
Presidency; Chamba Leper Asylum, Native State of Chamba, Punjab (Hima- 
layas) ; Champa Leper Asylum, Central Provinces; Chandag Leper Asylum 
near Pithoragash, Almora restrict ; Chandkuri, Central Province; "Chris- 
taram; Leper Asylum for Homeless Lepers, see Asansol; Claire (Chandkuri) 
Leper Asylum, Central Provinces; Dehra Leper Asylum, Punjab (Himalayas) ; 
Dhamtari Leper Asylum, Central Provinces ; Dhar Leper Asylum. Central 
India ; Dharmsala Leper Asylum, Punjab ; Ellichpur Leper Asylum, Central 
Provinces; Govindpur Leper Asylum, Bengal; Grace Away Mayne Leper 
Asylum, see Meerut, United Provinces ; Hurda Leper Asylum, Central Prov- 
inces ; Holt Skinner Memorial Hospital, see Rurki, Punjab ; Kagrapeth Leper 
Asylum, see Ahmedabad ; Kodur Leper Asylum, Madras Presidency ; Kothara 
Leper Asylum, Central Provinces ; Lohardaga Leper Asylum, Bengal ; Lud- 
hiana Leper Asylum, Punjab; Mandalay Leper Asylum, Burma (140 inmates) ; 
Mangaolore Leper Asylum, Madras Presidency ; Matunga Leper Asylum, near 
Bombay ; Maulmain Leper Asylum, Lower Burma ; Meerut, Grace Olway 
Mayne Leper Asylum, Miraj Leper Asylum, Bombay Presidency: Mourhhanj 
Leper Asylum, Orissa, Bengal; Moradabad Leper Asylum, United Provinces; 
Mungeli Leper Asylum, Central India ; Muzaffarngar Leper Asylum, United 
Provinces ; Muzaff arpur Leper Asylum, Bengal ; Nairn Leper Asylum, United 
Provinces; Nasik Leper Asylum Bombay Presidency; Neyoor Leper Asylum, 



TREATMENT OP PERSONS APFLICTED WITH LEPROSY. 95 

Native State of Travancore ; Patpara Leper Asylum, Central India ; " Phila- 
delphia " Leper Asylum, see Sulur, Madras Presidency ; Pithora Leper Asylum, 
Punjab ; Poladpur Leper Asylum, Bombay Presidency ; Poona Leper Asylum, 
Bombay Presidency ; Pui Leper Asylum, Bombay Presidency ; Purulia Leper 
Asylum, Bengal (TOO inmates,); Raipur Leper Asylum, Central Provinces; 
Ramachandrapuram Leper Asylum, Madras Presidency ; Raniganj Leper 
Asylum, Bengal ; Rawal Pindi Leper Asylum, Punjab ; Rivaz Wards Leper 
Asylum, see Tarn Taran, Punjab ; Rurki, Holt Skinner Memorial Hospital, Pun- 
jab ; Sabathu Leper Asylum, near Simla, Punjab ; Saharanpur Leper Asylum, 
Punjab; Salur (Vizagapatam) Leper Asylum, Madras Presidency; Salur 
" Philadelphia " Leper Asylum, Madras Presidency ; Sehore Leper Asylum 
(Bhopal), Central India; Sholapur Leper Asylum, Hyderabad; Sialkot Leper 
Asylum, Punjab ; Sylhet Leper Asylum, Bengal ; Tarn Taran Leper Asylum 
Rivas Wards, Punjab ; Trivandrum Leper Asylum, Native State of Travan- 
core ; Trombay, see E. F. Allbless Leper Home, Salsette Island, Bombay 
Presidency ; Udaipur Leper Asylum, Rajputaua ; Ujjain Leper Asylum, Central 
India ; Wardha Leper Asylum, Central Provinces. 

Note. — According to the census of 1911, there were then 73 leper asylums 
in India, with 5,116 inmates. 

Jamaica. — Lepers' Home, Kingston (117 inmates). ^ 

Japan.— Aornori Leper Asylum (Government) ; Kagawa Leper Asylum (Gov- 
ernment) ; Kioto Leper Asylum; Kumamoto Leper Asylum (Government); 
Kumamoto Christian Leper Asylum; Osaka Leper Asylum (Government); 
Tokyo Leper Asylum (Government) ; Tokyo Christian Leper Asylum ; " I-hai-en " 
Leper Asylum, Meguro near Tokyo. 

Madagascar. — Leper Lazar-house at Ilafy, Antananarivo; Leper Colony, 
Abohivaraka. 

Mauritius. — St. Lazare Leper Asylum (95 inmates). 

New Caledonia. — Leper Asylum, Pic des Morts, Bay of Canala ; Leper Asylum, 
Isle of Goats, Noumea. 

Norway. — St. Jorgens Hospital, Bergen (20 inmates) ; Pleiestiftelsen No. 1, 
Bergen (74 inmates) ; Reitjerdets Pleiestiftelse, Strinden ved Trondhjem (83 
inmates). 

Panama Canal Zone. — Palo Seco Leper Asylum (58 inmates). 

Philippines. — Culion Leper Settlement (3,602 inmates) ; San Lazaro Leper 
Hospital, Manila (205 inmates). 

Porto Rico. — Leper colony on the Isle de Cabras, at the entrance of San Juan 
Harbor ; leper colony on Goat Island. 

Portugal. — Hospital de San Lazaro, Lisbon (74 inmates) ; Leper Lazaretto, 
Funchal, Madeira. 

Russia. — Hospital for Lepers, Riga. 

Note. — There are 21 leper institutions in Russia, of which 17 are supported by volun- 
tary contributions. During the year 1911, 1,621 leprous patients were treated by physi- 
cians. (Russian Yearbook, 1015. ) 

St. Kitts, British West Indies. — St. Kitts Leper Asylum (69 inmates). 

St. Vincent.- — St. Vincent Leper Asylum (9 inmates)." 

Siberia. — Leper Colony, Villuisk, Eastern Siberia. 

Sierra Leone. — Male Leprosy Segregation Ward, Kissy. 

South Africa. — Almora Leper Asylum, Robben Island, off Capetown (612 in- 
mates) ; Leper Hospital, Em j any ana, Cape Colony (645 inmates) ; Leper Hos- 
pital, Amatikulu, Natal (175 inmates) ; Leper Hospital, Pretoria, Transvaal 
(792 inmates) ; Leper Hospital, Johannesburg. 

Southern Nigeria. — Leper asylums at Lagos, lbusa, and Onitsha. 

Spain. — Colonia Sanitaria de San Francisco de Bofja, Fontilles (Laguar), 
Provincia de Alicante; Hospital de San Lazaro, Santiago. 

Straits Settlements. — Leper Asylum, Pulau Jerejak (403 inmates) ; Leper Asy- 
lum, Singapore (52 inmates) : Female Leper Asylum, Jelutong (21 inmates). 

Sumatra. — Leper Asylum Huta Salem (100 inmates) ; Lagubot Leper Asylum. 

Sweden.— Jarfso sjukhus for spetiilske, Jiirfso (33 inmate*). 

Togoland. — Aussaetzigenheim Bogida (19 inmates). 

Trinidad. — Leper Asylum Cocorite (318 inmates). 

Turkey. — Moravian Leper Asylum, Jerusalem ; Leper Lazaretto, Damascus, 
Syria. 

United States.— Isolation Hospital, San Francisco, Cal. (15 inmates) ; County 
Hospital, leper ward, Los Angeles, Cal. (6 inmates) ; Leper Home of the State 



96 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

of Louisiana, Carville, La. (104 inmates) ; leper colony, island of Penikese, 
Buzzards Bay, Mass. (11 inmates). 

United States of Colombia. — Leper Lazaretto, Agua de Dios (520 inmates) ; 
Leper Lazaretto, Contracion, Province of Santander. 

Venezuela'. — Leper Lazaretto, Maracaibo, Zulia (477 inmates) ; Leper Laza- 
retto, Caracas (125 inmates) ; Leper Lazaretto, Estado de Sucre (9 inmates). 

Zanzibar. — Walezo Leper Asylum (95 inmates). 

Dr. Hoffman. The foregoing list emphasizes the almost universal 
practice regarding leper segregation in the civilized countries of 
the world. In many of the far eastern countries the settlements are 
not government institutions, but are administered by Christian mis- 
sions, or otherwise, and maintained by philanthropy and charity. I 
can not sufficiently emphasize my conviction, based upon a careful 
consideration of all the available evidence, that segregation alone 
provides an effective means of controlling the disease. 

The Chairman. Segregation, you say, is the only means? 

Dr. Hoffman. I am absolutely of this opinion, which is, I believe, 
shared by all the leading authorities on the subject throughout the 
world. 

The Chairman. Do you regard the public as being seriously en- 
dangered by the methods at present pursued in this country? 

Dr. Hoffman. I am unconditionally of that opinion, Senator: 
and I will go further and say that such cases as those which have 
recently occurred in New York and New Jersey show a reckless and 
almost criminal disregard of known safety precautions. I say this 
with reluctance, but really there seems no other word for this 
fatuous policy of indifference than " criminal," in, of course, a quali- 
fied sense of the term. If you have ever seen a single leper in the 
terminal state of the disease — and I have seen many of them — you 
will realize how needlessly the public is menaced by permitting 30 
and 80 lepers to be at large in New York and Chicago, respectively, 
as is claimed to be the case 

The Chairman (interposing). You mean 80 lepers in Chicago? 

Dr. Hoffman. Yes; 80, and. as said at the outset of my evidence, 
J had this statement confirmed by the board of health; but, as 
stated, the number actually knoAvn to the board is only three or four, 
the remaining number of cases being known to experts or specialists 
in skin diseases who are, as a rule, first consulted by lepers in the 
initial stages of the disease. 

The Chairman. And is there no segregation whatever? 

Dr. Hoffman. There is no effective segregation other than that 
the few apprehended cases are probably isolated in some poorhouse 
or isolation hospital, under conditions which must be more or less 
of a menace to the community. 

The Chairman. You think, then. Doctor, it is a very serious 
menace to the health of the people of the United States to allow the 
] 'resent methods to go on? 

Dr. Hoffman. I can, perhaps, best explain my point of view by 
stating that my professional duties as statistician of the Prudential 
require me to cooperate with public-health authorities and health- 
promoting agencies in every reasonable manner as regards methods 
and means of preventing disease and prolonging human life; and 
that if I did not feel that leprosy was of sufficient present or future 
importance to life insurance interests I would probably not have 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 97 

gone as extensively into this matter as I have. It is. of course, only- 
one of many phases of our public- welfare work, but having had these 
exceptional opportunities for observation and inquiry, I conceive it 
to be my duty to present the facts of a lamentable situation to the 
public for consideration. Aside, however, from the professional 
point of view, I feel strongly, on the one hand, the seriousness of 
the present situation as regards the general public, and as best illus- 
trated by the two cases of the last few clays just brought to your 
attention ; and, on the other, the urgency of more humane methods 
of treatment and care as regards the lepers themselves. 

The Chairman. That, in other words, is 3^our official point of view 
as statistician of the Prudential Insurance Co. and your private 
view as regards the Christian and humanitarian duty on the part of 
the general public ? 

Dr. Hoffman. Yes, Senator. 

The Chairman. How would you describe, Doctor, the danger to 
the public? Do you mean to say that the disease is on the increase 
and that as the lepers at large travel about they infect others? 

Dr. Hoffman. Unquestionably; for how could it be otherwise? 
Every case that we know of, Senator, at least every case that has 
been sufficiently investigated, indicates some previous connection 
with a center or focus of infection. The leper girl referred to in 
this morning's Sun came from Key West, which, notoriously, has 
been more or less infected with leprosy at different times from Cuba 
or other parts of the West Indies, where the disease is quite common. 
I have among my records another case of a man afflicted with lep- 
rosy in the city of New York whose infection was traced to Key 
West. The Bahama Islands are also a source of infection. Most of 
the lepers, for some unknown reason, are poor people, and they often 
live for months, and even for years, in back-room tenements, with 
the practical certainty of infection to others. No one knows exactly 
how the disease is spread from person to person, but practically every 
case can be traced back to some center or focus of infection. 

The Chairman. Is the disease exclusively among poor people, or 
does it exist also among people of means ? 

Dr. Hoffman. Leprosy is almost entirely confined to the poor, but 
there are some very curious and marked exceptions. In Honolulu 
during my visit to the islands last year a well-known and highly 
esteemed school-teacher — a white woman — was found to be a leper, 
and she is now at Molokai. When finally diagnosed as a leper she 
was in a fairly advanced stage of the disease, and Dr. McCoy, who 
was a member of the board who examined her, is present in this 
room. How she contracted the disease, or whether she contaminated 
others, is unknown. There are some such cases every year. While 
the disease is diminishing in most countries, it is apparently decreas- 
ing only where it is under control by unconditional segregation. 

Senator Works. I asked a question a while ago as to the number of 
new patients that are taken in at Molokai. Can you inform me 
about that? 

Dr. Hoffman. Yes, Senator; I have with me the statistics for 
Molokai for a period of years, and I submit the following table for 
inclusion in the record. 

The Chairman. If no objection is made, the table will be printed. 



98 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

(The table referred to is here printed in full, as follows :) 
Statistics of the leper settlement at Molokai, 1S70-1915. 



Year. 


Lepers ad- 
mitted to 
Molokai. 


Admission 

rate per 

10,000 of 

population 

of Hawaii. 


Year. 


Lepers ad- 
mitted to 
Molokai. 


Admission 

rate per 

10,000 of 

population 

of Hawaii. 


1870-1879 


1,495 
1,968 

1,276 

805 
40 


23.8 
24.3 
11.7 
4.5 
2.0 


1912 


91 
113 
67 
49 


4.4 






5.2 










1915 


2.1 













Dr. Hoffman. You will note, Senator, that according to this table 
the leper admission rate has diminished from 23.8 per 10,000 of popu- 
lation to 2.1 per 10,000 during 1915. During the earlier years, how- 
ever, the apprehensions were less complete, so that the actual diminu- 
tion in the frequency of leprosy has been even greater than shown by 
the table. The number of new admissions during 1915 was only 19. 

Senator Works. Have you also the death rate for the number of 
deaths per annum ? 

Dr. Hoffman. Yes, Senator; I have with me a table showing in 
the same manner the number of lepers who died at Molokai. 

The Chairman. If no objection is made, the table will be printed. 

(The table referred to is here printed in full, as follows :) 

Deaths of lepers at Molokai, Haicaii, 1870-1915. 



Years. 


Popula- 
tion. 


Deaths. 


Rate per 
10,000. 


Years. 


Popula- 
tion. 


Deaths. 


Rate per 
10,000. 




627, 258 

809.576 

1,091', 059 

1,714,394 

200,520 


1,157 
1,447 
1,443 
1,070 
61 


18.4 
17.9 
13.2 
6.2 
3.0 


1912 


209, 132 
217.744 
227; 391 
231, 210 


64 
49 
75 
62 




1SS0 1SX!) 






1914 


3.3 




1915 


2.7 


1911 











Dr. Hoffman. You will note, Senator, that according to this 
table 62 lepers died during the year 1915. 

Senator Works. My question is as regards the island of Molokai. 

Dr. Hoffman. The deaths from leprosy at Molokai probably con- 
stitute the entire mortality; but I have not with me at this moment 
a separation of the deaths from leprosy at Molokai from all the 
deaths from leprosy in the Territory of Hawaii. 

Senator Works. Then it would appear that in some years there 
are more new patients taken in at Molokai than there are deaths 
during the year. 

Dr. Hoffman. Yes, Senator ; at least it would seem to be so. 

Senator Works. Practically, I assume, there are none discharged 
as cured. 

Dr. Hoffman. Some are discharged, not as cured, but in a suffi- 
ciently arrested stage of the disease to be harmless as regards the 
community at large. As far as my information enables me to answer 
this question, there have been 118 persons discharged from Molokai, 
not as cured, but as well and free from clinical evidence of leprosy 
after prolonged treatment. The final judgment in this matter rests 
with a board of qualified experts appointed for the purpose. Simi- 



TEEATMENT OF PEESONS AFFLICTED WITH LEPBOSY. 99 

lar results have been reported for the leper settlement at Louisiana 
by Dr. Hopkins and Dr. Dyer. My statement as regards Molokai 
is on the authority of the physician in charge, Dr. William J. Good- 
hue. I am also informed as regards successful cases of treatment 
at many other leper settlements where the patients were taken care 
of under proper conditions. No one questions, in the light of a 
world-wide experience, that through segregation alone can leprosy 
be brought under public control with the practical certainty of 
ultimate, though very gradual, eradication. 

Senator Works. Does your data show the proportionate number 
of deaths that have occurred during the period since segregation has 
been practiced in Hawaii ? 

Dr. Hoffman. I have not all the data with me for the purpose, 
but I have before me a table showing the mortality from leprosy in 
the Territory from 1902 to 1914. 

The Chairman. Do you include both of those years? 

Dr. Hoffman. Yes; both years are inclusive — 1902 to 1914. 

Senator Works. What would be the leprosy mortality rate of 
Hawaii per annum ? 

Dr. Hoffman. The rate per annum during the period under 
observation has varied between a maximum of 5 per 10,000 during 
1902 and a minimum of 2.2 per 10,000 during 1908; during 1914 
the rate was 2.6. In other words, in proportion to the total mortality, 
the leprosy mortality is comparatively small. Out of 3,707 deaths 
from all causes during 1914, the number of deaths from leprosy in 
the Territory of Hawaii was 59, or 1.6 per cent. 

The Chairman. Does it appear from these statistics as though we 
could reasonably expect leprosy to be completely eradicated from the 
islands in the future? 

Dr. Hoffman. Unquestionably. 

The Chairman. In the near future? 

Dr. Hoffman. No; that would be quite impossible. In fact, Sen- 
ator, your question brings me precisely to the main point of this 
discussion, for if leprosy once gains a foothold it is extremely hard 
to eradicate the disease, which may continue to prevail, though to a 
very limited extent, for many years. 

At Tracadie, New Brunswick, for illustration, the Government 
leprosarium was established in, I think, 1846. The number of cases 
under treatment has probably never exceeded 30. Between 1815 and 
1915 only 193 deaths from leprosy appear to have been recorded in 
the Province. By 1891 the number of lepers under treatment was 22. 
It has fluctuated slightly, about 16 since that time, but according to 
the last official report for year ending January 1, 1916, the number 
under treatment was only 14, which, as far as I know, is the smallest 
number on record. There can be no question of doubt that if there had 
been no segregation the disease would have spread widely over the 
Maritime Provinces and into New England; under effective segrega- 
tion leprosy has been under control, and, as shown by the statistics, 
the number of lepers has now been reduced to 14. . 

I may call your attention in this connection to the fact that, the 
lazaretto at Tracadie, New Brunswick, is owned and controlled by the 
Canadian Government, which has another leprosarium on the Pacific 
coast, near Vancouver. Considering the introduction of foreign 
lepers into the Dominion chiefly orientals, but also a few Icelanders, 



100 



TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 



it is self-evident that segregation has been actually more effective than 
would appear from the statistics just quoted. There has. however, 
for at least 100 years been a local foci of the disease in New Bruns- 
wick and a small adjoining portion of the Province of Quebec. On 
March 31, 1914, according to an official return, there were then 19 
lepers, of whom 15 were native of the Province of New Brunswick, 
and of the 4 others 1 was Canadian born, 1 was from Barbados, 1 
from Iceland, and 1 from Russia. The Russian woman was dis- 
covered in Winnipeg during the preceding year in an advanced stage 
of the disease. 

One of the preceding Avitnesses referred to the new admissions to 
the leprosarium at Culion, in the Philippines. His statement seemed 
to imply that no new cases of leprosy were discovered in the islands, 
when, as a matter of fact, there are many new admissions every year. 

Senator Works. Will you give us the figures about that? 

Dr. Hoffman. Yes, Senator; the number of lepers admitted to the 
Culion leper colony during 1914 was 859; the number of lepers at 
the colony at the end of that year was 3,602. I can give you the 
record for the past 10 years if you care to include the statistics in the 
record. 

Senator Works. I think it would be well to include all of your 
statistics in the record. 

The Chairman. If you have a table there, Doctor, you might put 
it in. 

Dr. Hoffman. I have here an entire set of tables, Senator, which 
I am sure would make a valuable addition to the record. They have 
all been derived from official sources and can be relied upon as trust- 
worth}^. They constitute what is probably the most complete statis- 
tic;! 1 account of leprosy throughout the world. 

The Chairman. I think they should all go into the record, and we 
shall be pleased to put them in. 

(The tables referred to are here printed in full, as follows:) 





List of tables — leprosy statistics. 




No. 


Locality. 


Period. 

1900-1914 

1X96-MK 

1912-1911 

1914 


Title. 


1 


1 T nited States registration ai\ a 


Mortality. 

Admissions to leper home. 

Type of disease, by age. 

Inmates, by race. 

Mortality. 

Mortality, by race. 




do 




do 


5 
6 

7 


Hawaii 

do 

do 


1902-1915 

1911-1911 

1P66 1915 

190',-191-i 

1900-1914 

1906-1014 

1907-1914 

lS90-191fi 

190 5-1913 

1901-1914 

1901-1911 

1901-1913 

1909-1915 

1909-1915 

1913 






Known topers. 




do' 


in 


do 




11 




Statistics of Palo Seco Lepei 

Asylum. 
Statistics o( Tracadie. 
Mortality. 
Do. 

r»o. 


12 

la 


New Brunswick ■ 

Cuba 


14 

is 


fit. Kitts, Nevis, and Anguilh 


Hi 


Trinidad and Tobago 

do 


Do. 

Statistics ol Cocorite Leper 
Asylum. 

Admissions to Cocorite, by 
nativity. 

Inmates of Mabaica Leper 
Asylum, by race. 

Deat'bs, by duration of dis- 
ease. 

Deaths, by ape and sex. 

Deaths, bv cause. 

Mortality and number 0/ 
lepers. 

Mortality. 


IS 


do 


ifl 




?o 


do . 


1902-1913 

1902-1913 

1902-1913 

1905-1912 

1S91-1912 


21 

22 

n 


....do 

do 


24 


Brazil, Rio de Janeiro 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



101 



List of tables — leprosy statistics — Continued. 



No. 


Locality. 


Period. 


Title. 






1910-1912 

1907-1912 

1904-1912 

1901 


Mortality, by age and sex. 
Mortality. 
Do." 






97 




OS 




Lepers, by age and sex. 
Do. 


9Q 


do 


1910 


3(1 




1856-1910 

1910 




rtl 






3fl 


do 


1901-1910 






. do 


disease. 
Lepers, by age and sex. 
Mortality, by age and sex. 
Inmates in leper asylums. 
Number of lepers. 
Lepers, by domicile. 
Number of lepers. 
Do. 


34 


do 


1910 






1856-1913 

1907-1913 


36 


Swfx. n 




Finland 


1910 


39 




1911 








Lepers, by Provinces. 


41 




1S96-1912 

1906-1912. 

1906-1914 

1907 






Mortality and number of 

lepers. 










Lepers, by sex. 
Lepers, by Provinces. 
Cases treated in hospitals. 
Do. 




do':::::::::::::::::::::::::::::::::::::::::'' 




46 




1908-1913 

1910-1913 


47 








Number of lepers. 


49 




1912 






1890-1914 

1881-1911 

1910-1914 




51 




Lepers, by Provinces. 

Mortality, by race. 

Inmates of Pulau Jerejak 
Leper Asylum, by race. 

Imates of Pulau Jerejak Lep- 
er Asylum, by occupation. 

Lepers treated 'in hospitals. 

Mortality, by sex. 


51a 




5? 






do 






1909-1914 

1907-1911 

1907-1911 


55 




Rfi 











Table No. 1. — Mortality from leprosy in the United States registration area* 

1900-1914. 



Year. 


Population. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


Year. 


Population. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


1900 


30, 794, 273 
31,370,952 
32, 029, 815 
32,701,083 
33, 349, 137 
34, 094, 605 
41,983,419 
43,016,990 


4 
6 
5 
4 
4 
8 
3 
7 


0.1 
.2 
.2 
.1 
.1 
.2 
.1 
.2 


1908 


46,789,913 
50, 870, 518 
53,843,896 
59, 275, 977 
60,427,133 
63, 299, 164 
65,989,295 


11 
9 

10 
7 

11 
6 

12 


0.2 


1901 


1909 


.2 


1902 


1910 .... 


.2 


1903 


1911 


.1 


1904 . . 


1912 


.2 


1905 


1913 


.1 


1906 


1914 


.2 


1907 











Table No. 2. — Statistics of the leper home of Louisiana, 1896-1916. 
[Source: Tenth biennial report of the board of control for the leper home of the State of Louisiana, 1914.1 



Year. 


New 
cases ad- 
mitted. 


Number 
of in- 
mates. i 


Year. 


New 
cases ad- 
mitted. 


Number 
of in- 
mates. 


1896 


3 
6 
4 
7 
3 
10 
10 
11 
14 
9 
11 




1907 


8 
8 
18 
17 
15 
12 
25 
22 
21 




1897 




1908 


47 


1898... 


23 


1909 




1899 


1910.... 


66 


1900 


30 


1911 




1901 


1912 


74 


1902 


38 


1913 




1903..... 


1914 


. 87 


1904 


38 


1915 


102 


1905 


1916 


101 


1906 


47 













■ Census of inmates is recorded only biennially. 



102 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 3. 



-Cases of leprosy under treatment in the leper home of Louisiana 
according to type of disease, 1912-1914. 



Age. 



Col- 
ored. 



Col- 
ored. 



Col- 
ored. 



Col- 
ored. 



Type 

not 

stated, 

white. 



Under 15.. 

15-24 

25-34 

35-44 

45-54 

55-64 

65 and over 
Not stated. 

Total 



4 




7 




4 


1 


2 


1 


1 


1 




1 


1 





Table No. 4. — Number of inmates of the leper home of the State of Louisiana, 
Apr. 16, 191$, oy race. 





Popula- 
tion of 
Louisiana. 


Lepers. 


Rate 

per 
1,000,000. 




1,025,674 
739, 102 


72 
15 


70.2 




20.3 








1, 764, 776 


87 


49.3 







Table No. 5. — Mortality from leprosy in Hawaii, 1902-1915. 
[Source: Annual reports of the registrar general of the Territory of Hawaii.] 



Year ending 
June 30. 


Population. 


Deaths 

from 

leprosy. 


Rates 

per 

1,000,000. 


Year ending 
June 30. 


Population. 


Deaths 

from 

leprosy. 


Rates 

per 

1,000,000. 




160,078 
163,917 
167, 756 
171,595 


80 
46 
56 
64 


499.8 
2S0.6 
333.8 
373.0 


1911 


200,520 
209, 132 
217, 744 
227,391 


47 
50 
48 
59 


234.4 




1912 


239.1 




1913 


220.4 




1914 


259.5 




1911-1914... 
1915 




1902-1905... 


. 663,346 


246 


370.8 


854, 767 


204 


238.7 




175,434 
179, 273 
183, 112 
186.TO1 
190, 790 


58 
56 
41 
45 
68 


330. 6 
312.4 
223.9 
240.7 
356.4 


229,300 


39 


170.1 


1907 






1908 




1909 




1910 








1906-1910... 


915,560 


268 


292.7 





Table No. 6. — Mortality from leprosy by race in Haivaii, July 1, 1911-June SO, 

1914. 

[Source: Annual reports of the registrar general of the Territory of Hawaii.} 



Race. 


Aggregate 
population. 


Deaths 

from 

leprosy. 


Rate 
per 

1,000,000. 


Race. 


Aggregate 
population. 


Deaths 

from 

leprosy. 


Rate 

per 

1,000,000. 




86, 173 

41,4:11 
73, 791 
71, 695 


131 
4 
6 
11 


1,520.2 
96.6 

81.3 
153.4 




263, 665 
98,303 


3 
2 


11.4 


Part Hawaiian... 
Portuguese 


All others 

Total, 


20.3 


635,031 


157 


247.2 










TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



103 



Table No.- 7. — Statistics of the leper settlement at Molokai, Hawaii, 1866-1915. 



1866. 
1S67. 



1870. 
1S71. 

1S72. 
1873. 
1S74. 



1S75. 
1876. 
1877. 
1878. 
1879. 



1885. 
1896. 
1S87. 

1888. 



1890. 

1891. 

1892. 



1S00. 
1901. 
1902. 
1903. 
1904. 



1905. 
1906. 
1907. 
1903. 

190 < ; 



1911 K 
1912=. 

1913 2. 

1914 2. 

1915 2. 



Population 
of Hawaii. 



61, 949 
60, 939 



245, 776 



58, 919 
57, 909 
56,897 
58, S70 
60, 843 



3,-iSS 



62, 816 
64, 790 
66, 764 

68, 738 
70, 712 



333,820 



72.0-5 
74, 658 
76,631 
7-, CM 
-0,7:78 



383, 156 



82. 146 
83,715 

8-. 284 
86,873 
8^,922 



■26, 420 



89,990 
93, 161 
96,333 
99, 504 
102,675 



481.063 



105,846 
109,020 
120,26" 
131,510 
142, 755 



,396 



154,001 
157, 792 
161,583 

105.874 
169, 165 



707,915 



172.956 
176, 747 
180,538 

1-4,329 
191, £03 



Mil, 4 79 



100.520 
909,132 
217,744 
227,391 
231,210 



,085,997 



Admis- 
sions to 
Molokai. 



Deaths 
of all 
lepers. 



Rate per 
1,000,000. 



571.8 
387.4 
443.1 

994. 5 



594.0 



£67. 4 

898.0 

1,107.3 

2,412.1 

2.317.4 



1,550.6 



2, 372. 

l'932!2 

1,614.8 
2, 743. 5 



2, 102. 9 



2,077.5 
1, 727. 9 
1,448.5 
1,908.3 
2, 072. 5 



1, 847. 8 



1.728.6 
1,206.5 
1,301.5 
2,717.2 
1,685.1 



1,733.0 



1, 755. 8 
2, 254. 2 
1,577.9 
1,517.5 
1,548.6 



Number 
of lepers 
in Mol- 
okai Dec. 
31. 



1, 723. 2 



1,332.1 

1,045.7 

1,164.1 

865.9 

728.5 



1,005.9 



870.1 
1,030.0 
656.0 
610. 7 
632.5 



767.4 



549.3 
475.3 
4S7.4 
320.1 
430.8 



448. 



304.2 
305.0 
225.0 
329.8 
26S.2 



2S6.4 



3,321 



663 

600 

70S 

1,033 

1,187 



4,191 



1,213 
1,142 
1,095 
1,153 
1,123 



726 



1,115 
1,039 
1,059 
1.014 



5,374 



4,485 



5,882 



1 18 months, Jan. 1, 1909-June 30, 1910. 
Note.— Settlement established Jan. 6, 1866. 



Years ending June 30. 



104 



TREATMENT OF PERSONS AFFLTCTED WITH LEPROSY. 



Table No. 8. — Number of knonm lepers in the Philippine Islands, 1903-1914- 

[Source: Annual Reports of the Bureau of Health for the Philippine Islands.] 



Year. 


Popular 

tion. 


Known 

lepers 
in the 
islands. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Known 
lepers 
in the 

islands. 


Rate per 
1,000,000. 




6, 987, 686 
7,064,225 
7,140,764 
7,217,303 
7,293,842 
7,370,381 


3,323 

3,632 
3,580 
3,494 
2,826 
2,488 


475.6 
514.1 
501.3 
484.1 
387.5 
337.6 


1909 


7,446,920 
7,523,459 
7,000,000 
7,676,537 
7,753,070 
7,830,000 


2,273 

2,272 
2,506 
2,912 
3,442 
3,807 


305.2 




1910 






1911 


329.7 






379. 3 




1913 




1908 


1914 


486.2 









Table No. 9. — Admissions to the leper colony at Culion, Philippine Islands, 

1906-19U,. 

[Source: Report of the Bureau of Health for the Philippine Islands, 1914.] 



Year. 


Popula- 
tion of 
Philippine 
Islands. 


Admis- 
sions of 
lepers. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion of 
Philippine 

Islands. 


Admis- 
sions of 
lepers. 


Rate per 
1,000,000. 




7,217,303 
7,293,842 
7,370,381 
7,446,920 
7,523,459 


802 

690 

1,603 

1,378 

930 


111.1 
94.6 
217.5 
185.0 
123.6 


1911 


7,600,000 
7. 676, 537 
7; 753, 076 
7,830,000 


889 
965 
795 

887 


117.0 


1907 


1912 

1913 


125.7 
102.5 




1914 


113.3 


1910 













Table No. 10. — Mortality of lepers in the Culion Leper Colony, P. I., 1907-19 1 4. 

[Source: Annual Reports of the Bureau of Health (or the Philippine Islands.] 



Fiscal year ending 
June 30— 


Popula- 
tion. 


Deaths. 


Rate per 
1,000,000. 


Fiscal year ending 
June 30— 


Popula- 
tion. 


Deaths. 


Rate per. 
1,000.000. 




5,441,679 
7,332,111 
7,408,650 
7,485,189 
7,561,729 


205 
958 
802 
838 
427 


37.7 
130.7 
116.4 
112.0 

56.5 


1912 


7,638,268 
7,714,806 
3,876,538 
7,830,000 


531 
385 
290 
513 


69 5 




1913 




1909 


July l-Dec.31,1913. 
Calendar year 1914.. 


74.8 




65. & 


1911 









1 9 months only. 

Table No. 11. — Statistics of Palo Seco Leper Asylum, Panama Canal Zone, 

1907-1915. 

[Source: Annual Reports of the Department of Sanitation of the Isthmian Canal Commis- 
sion.] 



Popula- 
tion of 
Canal 
Zone. 



asylum. 



Rate per 
1,000,000. 



Inmates, 
Dec. 31. 



Rate per 

1,000,000. 



1907. 
1908. 
1909. 
1910. 
1911. 
1912. 
1913. 
1914. 
1915. 



102, 133 
120,097 
135, 180 
151,591 
156,936 
146,510 
129, 104 
123,592 
121,650 



7.4 
19.8 
12.7 
47.8 



137.1 
lR3.fr 
251.5 
237. 5 
312. 2 
327. 6 
348 a 
404 6 
476. 8 



Note. — Of the 62 lepers treated during the year ended June 30, 1915, 5 were white and 57 colored. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



105 



Table No. 11 



-Statistics of the leper lazarette at Tracadie, New Brunswick, 
1890-1916. 



Year. 


Number of pa- 
tients Jan. 1. 


Admitted during 
the year. 


"3 

O 

Eh 


Desertions or dis- 
charged, disease 
arrested. 


Deaths. 


3 


ri 

1 


■a 

o 

E* 




§ 

s 

o 


"5 


ri 


ri 

1 

o 


a 

o 


3 


ri 
1 


a 

Eh 


1890 


9 
8 
11 
14 
11 
12 
13 
14 
18 
15 
15 
14 
9 
10 
8 
9 
8 
8 
9 
10 
10 
14 
13 
13 
9 
7 
6 


11 
10 

11 

8 
9 
8 
6 
6 
6 

8 
7 
7 
7 
8 
6 
7 
7 
7 
8 
9 
9 
8 
8 
10 
9 
8 


20 
18 
22 
22 
20 
20 
19 
20 
24 
21 
23 
21 
16 
17 
16 
15 
15 
15 
16 
18 
19 
23 
21 
21 
19 
16 
14 


2 
4 
3 
1 
1 
1 
4 
8 


2 

2 

....... 

...... 


4 

3 
4 
1 

1 
4 
12 


24 
24 
25 
26 
21 
21 
23 
32 
24 
26 
24 
23 
17 
20 
19 
16 
16 
17 
19 
20 
23 
24 
23 
21 
22 
16 
14 


U 




l 


2 

1 


3 
1 
3 
2 
1 
2 
...„. 

...... 

1 
1 


























4 


































3 
4 
2 
2 
3 
3 














1898 


21 




l 


2 




2 
1 
1 
1 
1 
2 

...... 

2 

1 
4 

1 


3 

i 
...„. 

l 
l 
l 
l 
l 
l 

....„ 


5 
1 

2 

3 
3 

1 
2 
3 
2 
4 
1 
2 














1901 


32 




2 




1902 












3 
1 


1 
3 




1904 












41 




1 








1 


j 


1907 




M 


1 










1 
...... 

1 


j 


1909 








1 
2 














1911 


61 
61 




1 

1 


3 






1913 


2 
3 

1 


....... 

1 


2 




1 


2 


3 


















2 
















2 



















1 Disease arrested. 

2 "Went to Bermuda, his native land. 

3 Deserters. 



* Deserter; came back in 1909. 

5 Sent out by Dr. Smith; came back in 1912. 

6 Disease arrested; discharged by Dr. Langis. 



[Source : 


Sanidad y 


Beneflcencia, Boletin Oficial de la 


Secretaria 


Habana 


1 


Year. 


Population. 


Deaths 

from 

leprosy. 


Rate per i 
1,000,000. 


Year. 


Population. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


1903 


1,810,889 
1, 870, 412 
1,929,935 
1,989,458 
2,048,980 


31 
17 
29 
39 

47 


17.1 '• 
9.1 


1909 


2, 116, 402 
2, 150, 112 
2,183,823 
2,217,534 


25 
35 
53 
37 


11.8 


1904 


1910 


16.3 


1905 

1906 


15.0 
19.6 1 
22.9 ' 


1911 

1912 


24.3 
16.7 




1908-1912... 






10 750, 562 


180 


16.7 


1903-1907... 


9,649,674 


163 






2,251,245 


43 


19.1 


1908 


2,082,691 


30 


14. 4 ! 











Table No. 14. — Mortality from leprosy in St. Kitts, Nevis, and Anguilla, 1901- 

1914. 

(Source: Medical reports on the sanitary condition of the Presidency of St. Kitts-Nevis and the Island 
of Anguilla, Leeward Islands Colony.] 



Year. 


Population. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


Year. 


Population. 


Deaths 
from 

leprosy. 


Rate per 
1,000,000. 


1901 


46, 776 
46, 580 
46,346 
46,086 
45, 865 


9 
2 

12 
7 

15 


192.4 
42.9 
258. 9 
151.9 
327.0 


1909.. 


44,674 
44,508 


16 
11 


358.2 


1902 


1910 


247.1 




1906-1910. . . 




1904 


225, 271 


50 


222.0 








43,303 
43,711 
44,279 
44,847 


6 
10 

4 
6 




1901-1905... 


231,653 


45 


194.3 


1912 


228.8 






90.3 
133.8 


1906 . 


45, 655 
45, 335 
45, 099 


5 
11 


109.5 
242. 6 
155.2 


1914 




1911-1914.'. 




1908 


176,140 


26 


147-6 











106 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 



Table No. 15. — Mortality from leprosy in Antigua and Barbuda, 1901-1911. 
[Source: Annual reports of the registrar general on the vital statistics, Antigua.] 



Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 




35,073 

34, 792 
34,511 
34, 230 
33, 950 


7 
3 
10 
5 
9 


199.6 
86.2 
289.8 
146. 1 
2G5. 1 


1907 


33,390 
33, 110 
32,830 
32, 550 


4 

4 
3 


119.8 




1908 


211.4 




1909 


121.8 




1910 


92.2 




1906-1910. . . 






165, 550 


20 


123.8 


1901-191.3... 


' 172, 556 


34 


197.0 


32 269 


4 


124.0 




33,670 


2 


■ 59.4 









Table No. 16. — Mortality from leprosy in Trinidad and Tobago, 1901-1913. 

[Source: Annual reports of the registrar general on the vital statistics, Trinidad.] 



Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 




275,261 
2-2,125 
2S7, 737 
233,460 
239,236 


59 
43 
38 
41 
06 


214.3 
152.4 
132.1 
139.7 
223.5 


1908 


317,513 
323,823 
330, 270 


49 
52 
45 






1909 






1910 


136.3 




1906-1910. . . 
1911 




1905 


1,588,181 


261 


164.3 






1901 1905... 


1,437,879 


247 


171.8 


336,839 
343, 40S 
348, 958 


41 
42 
41 


121.7 






122.3 
117.5 




305,249 
311,321 


49 
66 


160.5 
212.0 


1913 













Table No. 17. — Statistics of the Cocorite Leper Asylum, Port of Spain, Trinidad, 

1909-1915. 

[Source: \nnual reports of tho surgeon general of Trinidad] 



Years ending Mar. 31 — 


Popula- 
tion of 
colony. 


Lepers 
admitted. 


Deaths. 


Remain- 
ing at 
end of 
year. 


Rate per 
1,000,000. 




317,513 
323, 828 
330, 270 
336, 839 
343,408 
318,958 
3j>5, 627 


60 

'""65' 
90 
96 
98 
110 


38 

3-i" 

38 
39 
25 
47 


251 
273 
273 
285 
283 
300 
31S 


700. 5 




8S3.0 








846.1 


1913 


824.1 




859.7 




894.2 







Table No. IS. — Admissions to the Cocorite Leper Asylum, Port of Spain, Trini- 
dad, according to nativity, Apr., 1909-Mar. 81, 1915. 

[Source: Annual reports of the surgeon general of Trinidad and Tobago.) 



Where born. 


Tuber- 
cular. 


Anes- 
thetic. 


Doubtful 
Mixed, and not 
stated. 


Total. 




SO 

i 

9 

18 
4 


98 
5 
3 
4 
6 


8 


20 
2 
2 
2 
2 
1 


212 














1 


16 










5 




1 








1 






1 








1 






1 






1 


St. K itts 


1 




1 


2 




1 
3 
2 




1 
















1 




3 




1 












1 


1 


China 


1 
37 


2 

156 






India 


10 


19 


222 






Total 


171 


277 


20 


51 


519 







TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



107 



Table No. 19. — Inmates of the public leper asylum at Mahaica, British Guiana, 
according to race, Apr. 1, 1913. 



[Source. Report of the surgeon general of British Guiana for the year 1912-13.) 



Race. 


Population 
of British 
Guiana. 


Number 
of lepers. 


Rate per 
1,000,000. 




155, 624 
128.993 

2,684 
10,284 

4,011 


222 
150 

1 
13 

1 
























Total 


301, 596 


387 









Table No. 20. — Deaths of lepers, by form and duration of disease, in Mahaica 
Leper Asylum, British Guiana, 1902-1913. 



Duration of disease 
(years). 


Tubercular. 


Anesthetic. 


Mixed. 


Total. 


Average dura- 
tion of treat- 
ment. 


Male. 


remale. 


Male. 


Female. 


Male. 


Female. 


Male. 


Female. 


Male. 


Female. 




1 
25 
66 

13 
13 


------- 

24 
17 
6 
13 


9 
63 
111 
90 
69 
74 


20" 

40 
21 
32 
29 


3 
9 

28 
20 
13 
10 


...... 

3 
5 
5 
3 


13 

97 
205 
158 
95 
97 


34" 

67 
43 
43 
45 


Yr. Mo. 

11 

2 6 

4 4 

6 8 

11 5 
2 1 


Yr.Mo. 




1 8 


5to9 


3 9 




6 1 




13 4 










Total 


166 


72 


416 


142 


83 


18 


665 


232 


5 3 


5 4 



1 Average duration of disease: Tubercular — Male, 8 years 10 months: female, 8 years 10 months. 
Anesthetic— Male, 10 vears 6 months: female, 11 years 2 months. Mixed— Male, 9 years 4 months; female, 
12 vears 11 months. All forms— Male, 9 years 11 months: female, 10 years 7 months. 

Male and lemale: Tubercular, 8 years' 10 months; anesthetic, 10 years 8 months; mixed, 9 years 11 
months; all forms, 10 years 1 month; average duration of treatment, 5 years 3 months. 

Table No. 21. — Deaths from leprosy, by sex and age, in Mahaica Leper Asylum, 
British Guiana, 1902-1913. 



Years. 


Under 15 years. 


15 to 44 years. 


45 years and 
over. 


Age not stated. 


All ages. 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 




1 




18 
32 
23 
17 
36 
42 
13 
12 
1 


7 
8 
7 
13 
13 
6 
4 
5 
1 


24 
31 
20 
19 
27 
26 
12 


4 
8 
3 
6 
5 
8 
2 






43 
63 
44 
37 
63 
83 
41 
60 
53 
58 
83 
37 


11 


1903 






16 


1904 


1 

1 


i" 








1905 






20 


1906 


I'4- 

15 
39 
51 
58 
11 


1 
1 
2 
27 
26 
30 
8 




1907 


1 




lo 


1908 


8 


1909 


9 | 

M 


32 


1910 






27 


1911 






30 


1912 


2 


i" 


35 
24 


15 

3 


35 13 


36 




13 


4 


8 


Total 










7 


2 


253 


82 


217 


53 


188 


95 


665 


232 







108 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 22. — Deaths of lepers, by cause, in Mahaica Leper Asylum, British 
Guiana, 1902-1913. 





Tubercular. 


A.iesthetic. 


Mixed. 


Total. 


Cause of death. 


Num- 
ber. 


Per 
cent. 


Num- 
ber. 


Per 
cent. 


Num- 
ber. 


Per 
cent. 


Num- 
ber. 


Per 
cent. 




113 
9 
12 
1 


47.5 
3.8 
5.0 

.4 


174 
37 
25 


31.2 
6.6 
4.5 


41 
6 
2 


40.6 
5.9 
2.0 


328 
52 
39 
1 

19 
31 
20 
11 
209 
18 
126 
7 
1 
35 


36.6 




5.8 




4.4 




.1 




19 
23 
15 

9 
134 
13 
74 

5 


3.4 
4.1 
2.7 
1.6 

24.0 
2.3 

13.3 
.9 






2.1 




7 
3 


2.9 
1.3 


1 
2 
2 

24 
3 

16 
2 
1 
1 


1.0 
2.0 
2.0 

23.7 
3.0 

15.8 
2.0 
1.0 
1.0 


3.5 




2.2 




1.2 




51 
2 
36 


21.4 

.9 
15.1 


23.3 




2.0 




14.0 




.8 








.1 




4 


1.7 


30 


5.4 


3.9 






Total 


238 


100.0 


558 


100.0 


101 


100.0 


897 


100.0 







Table No. 23. — Deaths from leprosy and number of inmates in the leper asylums 
of Venezuela, 1905-1912. 

I Source: Anuario Estadistico de Venezuela.] 



Year. 


Popula- 
tion. 


Peaths 
from 
leprosy 
in Vene- 
zuela. 


Rate 

per 

1,000,000. 


Inmates 
in leper 
asylums 
tec. 31. 


Rate 

per 

1,000,000. 




2,608,033 
2,627,434 
2, 646, 835 
2,666,236 
2,685,637 
2, 705, 038 
2,724,439 
2,743,840 


81 
74 
51 
37 
48 
22 
24 
62 


31.1 
28.2 
19.3 
13.9 
17.9 
8.1 
8.8 
22.6 














666 
632 
621 
612 
611 
582 


251.6 




237.0 




231.2 




226.2 




224.3 




212.1 







Table No. 24. — Mortality from leprosy in the city of Rio de Janeiro, 1891-1912. 
[Source: Annuario de Estatistica Pemographo-Sanitaria, 1912.] 



Year. 


Popula- 
tion. 


Peaths. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Peaths. 


Rate per 
1,000,000. 




440, 118 
450,636 
461,411 
472,454 
483,773 


13 
14 

20 
18 
18 


29.5 
31.1 
43.3 

37.' 2 


1902 


571, 728 
585, 695 
600, 067 
614,831 


19 
20 
23 
25 


33.2 




1903 


34.1 




1904 


38.3 


1894 


1905 


40.7 


1895 


1901-1905... 




2,930,451 


103 


35.1 


1891 1895... 


2,308,392 


83 


36.0 


625, 756 
636,018 
637,089 
649,362 
669, 781 


22 
34 
20 
14 
11 




1S9C. 


495,380 
507,286 
519,503 
532,042 
544,917 


19 
18 
13 
22 
10 


38.4 
35.5 
25.0 
41.4 
18.4 


1907 


53.5 




1908 


31.4 




1909 


21.6 




1910 


16.4 




1906 1910. .. 







3,218,006 


101 


31.4 


1896-1900... 


2,599,128 


82 


31.5 


708, 669 
749,376 


29 
25 


40.9 
33.4 


1901 


558, 140 


16 


28.7 


1912 









TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



10£ 



Table No. 25. — Mortality from leprosy in the Federal District of Rio de Janeiro, 
by age and sex, 1910-1912. 

[Source: Annuario de Estatistica Demographo Sanitaria, 1912.) 





Males. 


Females. 


Age. 


Popula- 
tion. 


Number 
of deaths. 


Rate per 
1,000,000. 


Popula- 
tion. 


Number 
of deaths. 


Rate per 
1,000,000. 




471,503 
145, 960 
363,953 
258, 332 
172,627 
85, 621 
35, 305 
13, 755 
33,631 


3 
9 
7 

13 
8 
4 


2.1 
20.6 
24.7 
27.1 
75.3 
93.4 
113.3 


406, 394 
127,310 
231,580 
166, 750 
114,175 
66,410 
34,618 
18, 800 
21, 555 








2 
6 
1 
3 
6 

1 


15.7 


20-29 


25.9 




6.0 




26.3 




90.3 


60-69 


86.7 




53.2 






















1, 580, 6S8 


45 


28.5 


1, 187, 592 


22 


18.5 







Table No. 26. — Mortality from leprosy in the city of Vernambuco, Brazil, 1907- 

1912. 

[Source: Annuario de Estatistica Demographo Sanitaria, Rio de Janeiro, 1912.1 



Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 




159, 480 
166,110 
172, 740 
179,370 


18 
19 
12 
12 


112.9 

114.4 
69.5 
66.9 


1911 


186,000 
210, 000 


3 

10 


16.1 




1912 


47.6 




1907-1912... 




1910 


1, 073, 700 


74 


68.9 







Table No. 27. — Mortality from, leprosy in the city of Sao Paulo, Brazil, 1904- 

1912. 

[Source: Annuario Estatistica Demographo-Sanitaria, Rio de Janeiro, 1912.] 



Year. 


Population. 


Deaths 
from lep- 
rosy. 


Bate per 
1,000,000. 


Year. 


Population. 


Deaths 
from lep- 
rosy. 


Kate per 
1,000,000. 




307,600 
314,800 
322,000 
329,200 


6 
7 
17 
11 


19.5 
22.2 
62.8 
33.4 


1908 


336,400 
343,600 
350,800 
358,000 


11 
6 
23 
21 




1905 


1909 


17.5 








1907 


1911 


58.7 




1908-1911... 
1912 




1904-1907... 


1,273,600 


41 


32.2 


1,388,800 
400,000 


61 
24 


43.9 









Table No. 28. — Number of lepers in Iceland, by age and sex, 1901. 

[Source: Sam-a3ndrag af statistiske Oplysninger om Island, Koebenhavn, 1907.] 





Males. 


Females. 


Age. 


Popula- 
tion. 


Number 
of lepers. 


J ate per 
1,000,000. 


Popula- 
tion. 


Number 
of lepers. 


T^ ate per 
1,000,000. 




17,326 
10,561 
6,464 
3,044 

188 


4 
30 
18 

8 


230.9 

2, 840. 6 
2,784.7 
2,628.1 


16,805 
11,653 
7,728 
4,620 
81 






20-39 


8 
19 


686.5 


40-59 


2., 458. 6 




1,515.2 


Not stated 














37, 583 


60 


1,596.5 


40,887 


34 


831.6 







Note.— The reports of the district physicians show 133 lepers in 1901. 
-S. Rept. 306, 64-1 8 



110 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 29. — Number of lepers in Iceland, by age and sex, 1910. 
[Source: Manntal a Islandi, 1. December, 1910, gefid ut af Stjornarradi Islands. Reykjavik, 1913.] 





Males. 


Females. 


Age. 


Popula- 
tion. 


Number 
of lepers. 


Rate per 
1,000,000. 


Popula- 
tion. 


Number 
of lepers. 


Rate per 
1,000,000. 




19, 141 
11,060 

7,542 

3,219 

143 


2 
10 
19 

7 


104.5 

904.2 

2,519.2 

2,174.6 


18,391 
11,800 
8,870 
4,905 
112 






20-39 


7 
10 
9 


593.2 


40-59 


1,127.4 




1,834.9 
















41, 105 


38 


924.5 


44,078 


26 


589.9 







Note. — The above table is derived from the census report of Iceland of 1910. The reports of the district 
physicians show that there were 82 lepers in Iceland in 1910, or 963 per 1,000,000 population. Fifty-one of 
the lepers were segregated in a leper asylum near Reykjavik. 

Table No. 30. — Number of lepers in Norway, 1856-1910. 

[Source: Norges officielle Statistik, v. 161, De Spedalske i Norge, Kristiania, 1912.] 



Year. 


Popula- 
tion. 


Number 
of lepers. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Number 
of lepers. 


Rate per 
1,000,000. 


1856 


1,494,000 
1,803,000 
1,930,000 
1,982,000 
2,063,000 
2,240,000 


2,858 

1,752 

1,195 

960 

688 

577 


1,913.0 
971.7 
619.2 
484.4 
333.5 
257.6 


1905 


2,315,000 
2,330,000 
2,345,000 
2,360,000 
2,375,000 
2,390,000 


474 
445 
438 
394 
360 
323 


204.8 




1906 . . 




1885 


1907 


186.8 








1895 


1909 


151.6 


1900 . 


1910 


135.1 









Table No. 31. — Number of lepers in Nortvay, by domicile, 1910. 
[Source: Norges officielle Statistik, v. 161, De Spedalske i Norge, Kristiania, 1912.] 



Province. 


Popula- 
tion. 


Number 
of lepers. 


Kate per 
1,000,000. 




241,884 
128,042 
152,306 
123,643 
109,076 
108,084 
76,456 
82,067 


5 
3 


20.7 




23.4 
































1 


12.2 








l,0jl..->fK 


9 


8.8 








119,236 
131,555 


1 

5 


8.4 




37.2 








253, 791 


6 


23.6 








141,040 
146,006 

90,040 
144,022 
148, 306 

76,867 


9 
56 
72 
40 
32 
12 


63.8 




383. 5 




799.6 




276. 6 




215.8 




156.1 








746,881 


221 


295. 9 








84,948 
Ml, '^7 
Si, 902 
38, 065 


24 
51 

8 

4 










97.7 




105.1 








369,602 


87 









TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Ill 



Table No. 32. — Average age of lepers at beginning of disease and duration of 
the disease in the leper asylums of Norway, 1901-1910. 

[Source: Norges officielle Statistik, v. 161, De Spedalske i Norge, Kristiania, 1912.] 



Year. 


Average age at the be- 
ginning of the disease. 


Average duration, in 
years, of the disease. 


Tubercular 
leprosy. 


Anesthetic 
leprosy. 


Tubercular 
leprosy. 


Anesthetic 
leprosy. 


1901-1905 


31.8 
31.3 


33.1 
31.0 


11.5 

16.1 


30.2 


1906-1910 


34.9 







Note. — The tubercular form of leprosy is decreasing more rapidly than the anesthetic form. The num- 
ber of persons suffering from the two forms is now about e'jual. 

Table No. 33. — Number of lepers in Norxvay, by sex and age, at the end of 1910. 

[Source: Norges officielle Statistik, v. 161, De Spedalske i Norge, Kristiania, 1912.] 



Age. 


Males. 


Females. 


Total. 


Age. 


Males. 


Females. 


Total. 


5-10 


1 




1 
1 
6 
22 
29 
53 

59 


60-70 


20 
14 

4 


29 
29 

I 

19 


49 




1 
3 

16 
13 
33 
35 


70 80 


43 




3 
6 
16 

20 
24 


80-90 


10 




90-100 








29 


48 




Total 




50-60 


137 


186 


323 









Table No. 34. — Mortality from leprosy in Noricay, by age and sex, 1906-1910. 
[Source: Norges officielle Statistik, v. 161, De Spedalske i Norge, Kristiania, 1912.] 



15-20 
20-30 
30-40 
40-50 
50-60 
60-70 



Males. 


Females. 


Total. 


6 


2 


g 


6 


2 


8 


18 


12 


30 


22 


11 


33 


11 


5 


16 


16 


13 


29 



Age. 



90-100 

Unknown. 



Table No. 35. — Number of inmates in the leprosariums of Norway, 1856-1913. 
[Source: Norges officielle Statistik, SundhedstLsttnden og Medicinallcrho.'deEe, 1913.] 



Year. 


Popula- 
tion of 
Norway. 


Number 

of 
inmates. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion of 
Norway. 


Number 
of 

inmates. 


Rate per 
1,000,000. 




1,494,000 
1, 803, 000 
1,930,000 
1,9S2,000 
2,063,000 
2,240,000 


235 
623 
522 
507 

29S 


157.3 
345.5 
270.5 
255.8 
174.5 
133.0 


1905 


2,315,000 
2, 390, 000 
2,405,000 
2, 420, 000 
2, 435, 000 


253 
203 
191 
177 
177 






1910 


84.9 


1885 

1890 


1911 

1312 


73^1 


1895 


1913 


72.7 


1900 









-This table shows that not all the lepers of Norway are segregated in asylums. See table No. 30. 
Table No. 36. — Number of lepers in Stveden, 1907-1913. 

[Source: Sveriges oifieiella Statistik, Afman Hal.-ooch Sjuk\ ard.l 



Year. 


Popula- 
tion. 


Number 
of lepers. 


Rale per 
1,000,000. 


Year. 


Popula- 
tion. 


Number 
ot lepers. 


Rate per 
1,000,000. 


1907 


5,406,615 
5,445,211 
5, 483., 807 
5,522,403 


87 
73 
73 
72 


16.1 
13.4 
13.3 
13.0 


1311.. .. 






1908 


1912 


5.601,195 
5,640.591 


65 




1909 






1910 











112 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 37. — Lepers in Sweden at the end of 1912, according to place of oriptn. 

[Sources: Sveriges offkiella Statisti" . Allman Hiilso och Sjukvard Ar 1912.] 



Stockholm city 

Stockholm County 

1 ppsala County .'. 

Kalmar Counts 

(iottland County 

Qoteborg and Bohus Comities. 

Al vsborg ( 'or.nty 

Kopparberg County 

( ; ii vlel iorg County 

Viisternoniand County 

Jamtland County 

Other l'rov inees. 



Total. 



Population. J35X ?&.& 



:cc,MS 

2o2.390 
129.965 
231.323 
35,990 
3.SC..60S 
291 720 
237,147 
2,7.345 
254,019 
163 625 
.014,215 



,601,195 



5. S 
4.5 

7.7 
4.3 

35.7 
2 6 
3.4 

84.3 
120.5 

19.7 

12.2 
0.0 



12.0 



Note.— The two infected Provinces, Kopparberg and Gavleborg, are situated in the north-central p»«t 
of the country from the Baltic to the Norwegian frontier. 

Table No. 38. — Number of lepers in Finland, 1910. 

[Source: Medicinalstyrelsens Berattelse for Ar 1910, Helsingfors, 1912. | 





Population. 


Number 
of lepers. 


Rate pw 
1,000,000. 




1,546,694 
1,568.503 


42 
38 


27.2 




21.2 






Total 


3,115,197 


80 


25.7 







Note.— During 1910 there were 7 new cases and 9 deaths from leprosy. 

Table No. 39. — Number of lepers in Prussia, 1911. 
[Source: Das Gesundheitswesen des Preussischen Staates im Jahre 1911. J 



Province. 


Population. 


Number 
of lepers. 


Rate per 
1,000,000. 


Province. 


Population. 


Number 
of lepers. 


Rate per 
1,000,000. 




916, 533 

606, 950 

544, 660 

1,262,099 


'85 
1 
1 
3 


92.7 
1.6 
1.8 
2.4 


Other Provinces. . 
Total 


37, 170, 041 






Gumbinnen 

Arnsberg 

Coin 






40, 500, 283 


90 


2.2 







I All in the district of Memel. 

Table No. 40. — Number of lepers in Spain, 190.'f. 

|Source: Dr. Ph. Hauser. La Geografia Medica de la Peninsula Iberica.) 



Province. 


Population. 


Number 
of lepers. 


Rafp per 
1,000,000. 


Province. 


Population. 


Number 
of lepers. 


Ra'e per 
LOOO.OOO. 




475, 684 
457, 683 
314,632 
469, 774 
655, 046 
4P7, 035 
277. 4S9 
506, 349 


117 

70 
21 
21 
27 
6 
67 


246.0 
2.2 

222.5 
44.7 
32.1 
54.3 
21.6 

132.3 


Pontevedra 


464,552 
568.028 

336,978 
825, li 10 

12, 740, 660 


27 

34 

9 

122 




Cadiz 






Tarragona 










All other Prov- 










Total 








18,589,016 


522 









Note.— The Canary Islands are not included in the above table. During the years 1901-1906 there were 
V5 deaths from leprosy in the Canary Islands, giving an annual death rate of 32.9 per 1,000,000 population. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



113 



Table No. 41. — Mortality from leprosy in Italy, 1896-1912. 
[Source: Statistiea delle cause di morte nell "anno 1912, Roma, 1914.] 



Year. 


Popula- 
tion. 


Deaths 

from 
leprosy. 


Rate per 
1,000,000. 


Year. 


Popula- 
tion. 


Deaths 

from 

leprosy. 


Rate per 
1,000,000. 




31,506,302 
31, 710, 318 
31,926,334 
32, 136, 350 
32, 346, 366 


17 
21 
27 
14 
11 


0.5 

.7 
.8 
.4 
.3 


1906 


33,325,098 
33, 514, 702 
33,826,688 
34,077,068 
34,376,609 


10 
10 
9 
14 
20 












1908 












1910 




l^ivisoo. . . 




1906-1910... 




159,631,670 


90 


.6 


169, 120, 165 


63 


.4 




6 
5 
11 
12 
12 


.2 
.2 
.3 
.4 
.4 


34,688,814 
35,026,486 


19 
17 


- 




1912 


.5 


1903 

1904 

1903 

1901-1905... 


32,839,509 
33, 016, 234 
33,193,289 






164,281,879 


46 


.3 





Table No. 42. — Number of lepers and mortality from leprosy in Bosnia and 
Herzegovina, 1906-1912. 

[Source: Jaehrliche Beriehte ueber die Yerwaltung von Bosnien und Hercegovina.] 



Year. 


Popula- 
tion. 


Number 
of deaths. 


Rate per 
1. 000.000. 


Number 
of lepers. 


Rate per 
1,000,000. 




1,634,082 
1,700.072 
1.766,062 
1,832.053 






150 
135 
135 
129 
130 




1907 


24 
1.5 

10 


14.1 
8.5 

14.7 
5.3 


79. 4 






1909 




1910 




1911 


' 




1912 


1,962,411 





116 













Table No. 43. — Statistics of the leper farm at Nicosia, Cyprus, 1906-J91'f. 
[Source: The Governor's Annual Reports.] 



Year. 


Popula- , Number 1 Rate per ! J^^f 
tion. of deaths. 1,000,000. : on ^ ec - 

i 


Rate per 
1,000,000. 


1906 . 


256.490 ' 


99 
100 
102 
102 
99 
99 
97 
95 
97 




1907 


260 199 | 11 1 42.3 
263,908 j 5 18.9 
267.617 1 11 ] 41.1 
271,326 1 15 55.3 
275.035 9 32.7 
27S.744 1 ! 




1908 




1909 




1910 




1911 


360. 


1912 




1913 


282,453 | 14 I 49.6 
2S6. 162 10 34. 9 




1914 









Table No. 44. — Number of lepers in Egypt, according to the census of 1907, by 

sex. 

[Source: The census of Egypt taken in 1907: Cairo, 1909.] 





Popula- 
tion. 


Number 
of lepers. 


Rate per 
1 ,000.000. 




5,616.640 


4,287 


763. 3 




5.573.338 


2,226 i 399.4 


Total 




11.1S9.978 











114 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 45. — Number of lepers in Egypt, according to the census of 1907, by 

Provinces. 





Popula- 
tion. 


Number 
of lepers. 


Rate per 
1,000,000. 


GOVERNORATE3. 


654, 476 
33?, 246 
49,884 
18, 347 
11,448 
5,897 
1,510 


54 

101 

2 


82.5 




304.0 




40.1 




0.0 




4 

10 


349.4 




1,695.8 




0.0 








PROVINCES. 


798, 473 
1,484,814 
912, 428 
879, 646 
970, 581 
434,575 


1,022 

707 
568 
899 
316 
302 


1,279.9 
476.2 






622.5 




1, 022. 




325.6 




694.9 








5,480,517 


3,814 


695.9 








460, 080 
372,412 
441,583 
659, 967 
903, 335 
792,971 
772,492 
232, 813 


169 
152 
262 

445 
655 

487 
50 


367.3 




408.2 




593.3 




466.7 




492.6 




826.0 




630.4 










Total, upper Egypt 


4,635,653 


2,528 


545.3 



Table No. 46.— Cases of leprosy treated in the hospitals and dispensaries of 

Sierra Leone, 1908-1918. 

[Source: Annual Reports of the Medical Department of Sierra Leone.] 



Year. 


Pooula- 
tion. 


Cases. 


Rate per l 

1,000.000. ! 


Year. 


Poiinhv 
tion. 


Cases. 


Rate per 
1,000,000. 


1908 


75,896 
75, 788 
75, 680 


27 
12 
26 


355. 7 
158.3 1 
343.6 ! 


1911 


75,572 
75, 404 
75,356 


48 
34 
47 


635.2 










1913 






1 









Table No. 47. — Cases of leprosy treated in the hospitals and dispensaries of the 
Gold Coast Colony, 1910-1918. 

[Source: Annual Medical and Sanitary Reports of the Government of the Gold Coast.) 



Year. 


Population. 


Cases. 


Rate per 

1,000,000. 


Year. 


Population. 


Cases. 


Rate per 
1,000,000. 


1910 


857, 922 
853, 766 
849, 610 


40 
43 
34 


46.6 
50.4 
40.0 


1913 


845,454 


64 


75.7 




1910-1913... 






3, ,,.-,752 


1S1 









Type of disease, 1913: 

Tubercular 

Anesthetic 



Table No. 48. — Number of lepers in Zanzibar and Pemba, 1909. 
[Source: Report of the Public Health Department, Zanzibar, 1909.) 





Population. 


Number 

of 
lepers. 


Rate per 
1,000,000. 




115.477 
83, 437 


178 
129 


1,541.4 




1,546.1 




Total 


198, 914 


307 


1,543.4 





TREATMENT OP PERSONS APFLICTED WITH LEPROSY. 



115 



Table No. 49. — Number of lepers in the leper asylums in the Union of South 
Africa, Dec. 31, 1912. 

[Source: Statistical Yearbook of the Union of South Africa, 1913.] 





Cape of Good Hope. 


Natal, 
Amati- 
kulu. 


Trans- 
vaal. 
Pretoria. 






Robben 
Island. 


Emjan- 
yana. 


Total. 




eo 

32 
349 
171 






60 
32 
401 
299 


120 








64 




329 
316 


100 

75 


1,179 
861 










612 


645 


175 


792 


2,224 







Note.— As the population of the Union of South Africa was 6,125,000 on Dec. 31, 1912, there were 363.1 
lepers in leper asylums per 1,000,000 population. 

Table No. 50. — Mortality from leprosy in Mauritius, 1890-1914. 
[Source: Annual Reports of the Registrar General of Mauritius.] 



Year. 


Population. 


Deaths. 


Rate per 
1,000,000. 


Year. 


Population. 


Deaths. 


Rate per 
1,000,000. 




370,562 
370,604 
370,646 
370,689 
370, 732 
370, 775 
370, 818 
370,861 
370, 904 
370,947 
370, 990 
370,968 
370, 745 


66 
35 
54 
59 
59 
54 
33 
41 
62 
44 
32 
48 
39 


178.1 
94.4 
145.7 
159.2 
159.1 
145.6 

no! 6 

167.2 
118.6 
86.3 
129.4 
105.2 


1903 


370,522 
370, 299 
370,076 
369,853 
369,630 
369,407 
369, 183 
36S, 959 
368,735 
368,512 
368,289 
368,066 


34 
30 
27 
11 

5 
20 
21 
14 
23 
20 
21 

1 






1904 






1905 






1906 






1907 












1909 












1911 












1913 










1902 











Table No. 51. — Number of lepers in India at each of the last four censuses, 

1881-1911. 

[Source: General Report of the Census of India, 1911.] 



Population 
1911. 






Rates per 1CO,CCO. 



Males. 



18S1 1831 1901 1911 



1881 1S91 1901 1911 



PROVINCES. 



Burma. 



Bengal 

Biharand Orissa 

United Provinces 

Central Provinces and Berar , 

Madras 

Coorg 

Bombay 

Ajmer Merwara 

Punjab 

Northwestern Frontier Province. 
Baluchistan , 



jNortnw 
Baluch 

Sikkim 
Centra] 
Cochin 
Travan 
Hydera 
Mysore 
Baroda 



II. STATES AND AGENCIES. 



kkim 

tral India Agency. 

'chin 

Travancore 

Hyderabad 

Mysore 



Rajputana Agencies. 
Kashmir 



12,115,217 
6.713,635 
45,483,077 
34,490,084 
47,182,044 
13,916,308 
41,405,404 

174, 976 
19,672,642 

501,395 
13,974,956 
2, 196, 933 

414,412 



87, 920 
9,356,9£0 
918,110 
3, 428, 975 
13,374,676 
5, S06, 193 
2,032,798 
10,530,432 
3, 158, 126 



All India 315,156, 



Note.— The total number of leper sin India, 1911, was 109,000. 



116 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



Table No. 51a. — Mortality from leprosy in Ceylon, 1910-191^, by race. 

[Source: Administration Reports of Ceylon, Vital Statistics.! 



Race. 


Population. 


Deaths 

from 

leprosy. 


Kate per 
1,000,000. 




38,605 

134,905 

13, 76 1, 410 

5.34S, 670 

1,352,420 

65, 495 




0.0 




4 

256 
53 
22 
2 


29.7 




18.6 




9.9 




16.3 




30.5 








20,709,505 


337 


16.3 







Table No. 52. — Lepers treated in the leper asylum at Pulau Jerejak, Straits Set- 
tlements, during the year 191^, according to race, compared with the popula- 
tion of Straits Settlements and Perak. 1 

[Source: Annual Report on the Medical Department, Straits Settlements, for the year 1914. J 



Race. 


Popu- 
lation. 


Cases. 


Rate per 
1,000,000. 


Race. 


Popu- 
lation. 


Cases. 


Rate per 
1,000,000. 




191,453 

158, 766 
70,438 
96,992 
30,838 
38,562 


7 
191 

75 
158 

28 


1203! 
1064.8 
1629. 
908.0 




119,671 
35,923 

408,042 
30,801 
8,917 
17,723 


47 
4 
3 






Other East Indians. 


111.3 
















1 


112.1 




Other races 

Total 














Total Chinese 


587, 049 


526 


896.0 


1,208,126 


581 


480.9 













' Of the 581 cases 542 were from Perak or Straits Settlements. 

Table No. 53. — Lepers treated in the leper asylum at Pulau Jerejak, Straits 
Settlements, during the year 191 't, according to occupation. 

[Source: Annual Report on the Medical Department, Straits Settlements, for the year 1914.) 



occupation. 


Cases. 


Per cent. 


Occupation. 


Cases. 


Per cent. 




204 
181 
29 
23 
15 
13 
9 
8 
6 


35.1 
31.2 
5.0 
4.0 
2.6 
2.2 
1.5 
1.4 
1.0 




6 
6 
5 
4 
2 
70 


1.0 












0.9 






0.7 






0.3 






12.1 




Total 






581 


100.0 













Note.— The occupational census statistics of Straits Settlements are too incomplete to serve for compar- 
ison with the above figures. 

Table No. 54. — Leprosy treated in the hospitals of the Federated Malay States, 

1910-1914- 

[Source: The Annual Medical reports for the Federated Malay States.] 



Year. 


Popula- 
tion. 


Admissions to hos- 
pitals. 


Deaths from leprosy. 


Remaining at end of 
year. 


Number. 


Rate per 
1,000,000. 


Number. 


Rate per 
1,000,000. 


Number. 


P ate per 
1.000,000. 


190' 


955, 553 
1,001,257 
1,045,947 
1,103,017 
1,117,625 
1,125,000 










468 
523 
512 
547 
544 
564 




1910 


486 
404 
374 


485.4 
386.3 
337.2 


162 
136 
139 


161.8 
130.0 
125.3 


522. 3 


1911 




1912 




1913 




1914 


443 


393.8 


119 


105.8 


501.3 







TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



117 



Table No. 55. — Mortality from leprosy in Japan, 1907-1911. 
[Source: Mouvement de la population de PEmpire du Japon.] 



Year. 


Popula- 
tion. 


Deaths 

from 
leprosy. 


P ate per 
1,000,000. 


1907 


48,492,085 


1,889 
1,944 
1,935 
1,585 
1,623 


39.0 




49,045,240 
45,591,360 
50, 137, 4> 
50, 6S3, 600 


39.6 


1909 


39.0 




31.6 




32.0 








247,949,765 


8,976 


36.2 








Males. 


Females. 


Year. 


Popula- 
tion. 


Deaths 

from 
leprosy. 


E ate per 
1,000,000. 


Popula- 
tion. 


Deaths 
from 

leprosy. 


Tate per 
1,000,000. 


1907 


24,440,011 

24, 1 0S, 992 
24, 974, 209 
25,249,235 
25,524,261 


1,344 

1,412 
1,445 
1,117 
1,210 


55.0 
57.1 
57.9 
44.2 
47.4 


24,052,074 
24,336,248 
24, 61/, 151 

25,159,339 


545 
532 
490 
468 
413 


22.7 




21.9 




19.9 




18. S 




16.4 






1907 1911 


124,896,708 


6,528 


52.3 123. 053. 057 


2,448 


19.9 













Table No. 56. — New cases of leprosy m the Commonwealth of Australia, 
1901-1911. 





[Source: Official Year Book of the Commonwealth of Australia 


, 1913.) 




Year. 


Population. 


New cases. 


Rate per 
1,000,000. 


1907 


4,123,729 
4,194,410 
4,274,617 
4,370,185 
4,490,366 


26 
28 
14 
14 
11 


6.3 






1909 


3.3 


1910 ... 


3.2 




2.4 










21,453,307 


93 









Dr. Hoffman. In this connection an important question has been 
raised as regards the probable foreign origin of most of the cases 
reported for this country. Dr. Parker, of the Penikese colony, has 
been good enough to furnish me with an extremely interesting state- 
ment, in detail, regarding the 11 cases now at the island and 13 cases 
formerly under treatment. If this table is desired for the record, 
and I think it should be included, I have to request that the names 
of the "patients be omitted, and with your permission I will now 
strike out the names so tha t they will not be printed. 

The Chairman. We will include the table without the names. 



118 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



(The table referred to, without the names, is here printed in full, as 
follows:) 

List of cases of leprosy at Penikese Hospital Feb. 12, 1916. 





Pres- 
ent 
age. 


Sex. 


Civil 

status. 


Family. 


Nativity. 


Apprehended. 


Time 
in 


No. 


When. 


Where 
residing. 


United 
States 
prior 
to dis- 
covery. 




34 
35 

35 

70 

50 

51 

27 

40 
41 

28 

27 


Male 

...do.... 

Female . 

Male.... 
Female . 

...do.... 

Male.... 

...do.... 
...do.... 
...do.... 

...do 


Mother.. 
...do.... 

Son 

Wife.... 
...do.... 

Mother. . 
Son 

Mother.. 




Chinese... 
...do 

Russ i a n 
(Lett- 
ish). 

Rus s i a n 

(Hebrew). 

Cape de 

Verde. 

Italy 

Cape de 

Verde. 
Chinese... 
Japanese . . 
Rus s i a n 
(Hebrew). 
Greek 


June 6, 1904 
Jan. 18, 1905 

July 13,1907 

Mar. 19,1909 
Dec. 16,1909 

May 10,1911 
Nov. 9,1912 

Mar. 7, 1913 
Jan. 17,1911 
Nov. 7, 1913 

Nov. 8,1915 


Boston 

Newbury- 

port. 
Brookline. 

Boston 

New Bed- 
ford. 

Boston 

East Nor- 
ton. 

Boston 

...do 

Maiden . . . 

Boston 


Years. 
2-3 


2 
3 


Wife 

Father, mother, 3 sis- 
ters in Russia; broth- 
er in Concord; uncle 
in Cambridge. 


3 

7 

7 


5 

6 


1 daughter in New 
Bedford; 1 son, 1 
daughter in Brava. 


12 
4 


7 




4 


8 


Wife, 2 children 


8 
3 


10 

n 


...do.... 
...do 


2 brothers, 1 uncle in 
Boston. 


7 
31 











No. 


Form or type of 
disease. 


Present stage of disease. 


Esti- 
mated 
chan:es 
of life (a 
guess). 


Occupation. 


History: Ad- 
mitted to 
. Penikese. 


1 




Far advanced; not in final 
stage. 


Years. 
3 

4 
4 
1 

10-15 
3 
8 

7 

1 

7 
12 




Nov. 18,1905 


? 


do 

do 

do 


do 


Nov. 16,1905 
July 24,1907 


R 








Teacher of Jewish lan- 
guage 


5 




Dec. 19,1909 
May —,1911 
Nov. 10,1912 


f> 






do 


7 

8 


do 

Tubercular macular 


Second stage; medium ad- 
vanced. 


Laborer;cran berry pick- 
er. 


9 




Carpenter and general 
laborer. 


Jan. 23,1911 


in 


do 




Nov —,1913 


U 


do 






Nov. 18,1915 









TREATMENT OF PERSONS AFFLICTED WITH LEPROSY 
List of all previous 



119 



of leprosy treated or cared for at Penikese Hospital, 
1904-1915. 





Age 
at 
dis- 
cov- 
ery. 


Sex. 


Civil 
status. 


Family. 


Nativity. 


Apprehended. 


Time in 
United 


No. 


W hen. 


Where 
residing. 


States 
prior 
to dis- 
covery. 


1 

2 
3 

4 

5 


34 
26 

54 

2.3 
41 
19 
17 
25 

55 
31 

30 

72 


Male.... 

...do 

Female . 

Male.... 

...do 

...do 

Female . 

Male.... 
...do 


Mother.. 

Son 

Wife.... 

Mother.. 


Wile, S children 

4 children; fourth 

born at Penikese. 

Wife, 2 children.... 


Cape de 
Verde. 

.....do 

do 

A merican, 
New Or- 
leans. 

Trinidad 

Russian 

do 


Apr. 22,1904 

Aug. 14,1904 
Feb. 22,1905 

Oct. 29,1905 

Feb. 1,1907 
Aug. 27,1907 
Sept. 2,1907 
Mar. 22,1909 
Apr. 24,1909 

Mav 11,1912 
June 26,1912 

June 12,1912 

Dec. 9,1915 


Harwich.... 

Poston 

Wareham... 

Hyde Park.. 

Somerville.. 

Fast Boston. 

Prookline... 

Upton 

State In- 
firmary. 

Boston 

Ne\^ Bed- 
ford. 

Boston 

Bourne 


Yam. 
12 

14 
3-i 

( l ) 
2 


6 


Mother.. 


Wife, 5 children... 


4 
2 


g 


...do 

..do 




Barbados. .. 
Greek 

Russian 

Azores 

Chinese 

American... 


7 


<t 




2 


10 


...do 

...do 

...do 

...do 






20 


11 

12 
13 


Son 

Mother.. 
...do 


Wife and son in 

China. 
Wife and 1 child . . . 


15 

10 
32 





Form or type of disease. 


Occupation. 


History. 


No. 


Admitted to 
Penikese. 


Disposition. 


1 




Stevedore and laborer 


Nov. 18,1905 
Nov. 16,1905 
Nov. 29,1905 
Dec. —,1906 
May 31,1907 
Aug. 19,1907 
1907 
Mar. 27,1909 
Apr. 24,1909 
May 11,1912 

June 28,1912 
June 15,1912 
Dec. 19,1915 


Died Nov. 19, 1914. 


2 




Died 1907. 






Died Mar. 13, 1915. 


4 
5 


Clerk and accountant ...... 

Clerk 


Died Nov. 7, 1912. 
Died Aug. 8, 1913. 


6 






Died Oct. 22, 1915. 


7 


do 




Deported. 

Died Feb. 17, 1915. 

Deported. 

Mar. 21, 1913, discharged 


8 



Y///ao'.'///".Y.",'.~".'.'.'.'.'.~.'. 


student in his;h school 


in 


do 

do 




11 




for treatment elsewhere. 
Deported Aug. 13, 1912. 


n 


Anesthetic and macular 




13 


Mariner and bookkeeper . . . 


Died Jan. 23, 1916. 









1 Always 

Dr. Hoffman. It is shown by these tables that most of the cases of 
leprosy treated at Penikese were either Orientals or Portuguese, chiefly 
from the Western Islands. You, of course, are familiar with the fact 
that there is quite a Portuguese population in southeastern Massa- 
chusetts. With your permission I will read off the nativity of the 
patients under treatment, as follows: One Chinese, another Chinese, 
one Russian, another Russian, one Portuguese, one Italian, one Portu- 
guese, one Chinese, one Japanese, another Russian, and a Greek. In 
other words, Mr. Chairman, at the present time there is not a single 
A.merican-born leper in the colony. All of the cases, broadly speak- 
ing, are interstate or international cases, the patients having not been 
born and probably having not contracted the disease in Massachusetts, 
and, perhaps, not in this country. The facts are practicalry the same 
for the earlier cases, except that there was one from New Orleans, 
another from Trinidad, and another from Barbados, illustrating the 



120 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

menace of the West Indies as regards the introduction of new cases 
of leprosy into this country. You may recall that the Jersey City 
case referred to at the outset of my remarks had originally been 
exposed to the disease in the West Indies, and the second case had 
come from Key West. The Senator from California asked a ques- 
time some time ago as regards the controlling power of the Federal 
Government over lepers at large in this country, and I would like 
to suggest to the committee that Dr. McCoy be requested to explain 
concisely the operations of the Federal quarantine law as well as the 
rules and regulations of the Public Health Service regarding the 
transportation of lepers in interstate traffic. The amendment with 
reference to the interstate quarantine regulations regarding the trans- 
portation of lepers in interstate traffic was promulgated by the Treas- 
ury Department under date of May 15, 1912, and published by the 
Public Health Service in Public Health Report No. 84 of that year. 

Senator Works. There would be no doubt, Doctor, about the right 
of the Government to deal with interstate cases, but the important 
question is whether these cases are not all interstate cases; that is to 
Say, whether there is not a danger at all times of transmitting the 
disease from one State to another, which, of course, would involve 
the question of absolute Government jurisdiction over all these cases. 
Take such cases as have been mentioned here, where the patient goes 
from one State to another and is shunted back into his own State; 
that, obviously, is an interstate matter, with which the Government 
should be able to deal. 

Dr. Hoffman. With reference to this question, Senator, I would 
say that I am willing to commit myself to the point of view that 
almost all of the cases of which I personally have knowledge have 
an interstate aspect to them. 

The Chairman. Speaking of the interstate aspect of these cases. 
Doctor, what provision does the Government make for soldiers who 
return from the Philippines who had been discharged and who, 
subsequent to their discharge, have developed leprosy? 

Dr. Hoffman. As far as I know the Federal Government makes 
practically no provision for these unfortunates other than such as 
very special circumstances may require. There was a well-known 
case of a soldier leper at Savannah who for a number of years was 
properly taken care of in an isolated situation, as I recall it, near 
Fort Screven. 

The Chairman. Did the lepros} 7 develop after his discharge? 

Dr. Hoffman. No; I think not, Senator. As I recall the case the 
leprosy developed previous to discharge, and he was therefore still 
in the service. 

The Chairman. I was wondering if there was any provision made 
by the Federal Government for cases of leprosy in soldiers develop- 
ing after their discharge. 

Dr. Hoffman. As far as I know, there is no such provision, al- 
though quite a number of cases are on record where soldiers have 
developed the disease after they returned from the Philippines. 
There are, I believe, three such cases at the San Francisco settlement 
at the present time. 

The Chairman. The Early case, as I understand it, belongs to this 
class? 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 121 

Dr. Hoffman. Yes, Senator ; that would seem to be so. There ap- 
pears to be no question about Early having contracted the disease 
in the Philippines during military service ; but he is now being taken 
care of by the government of the District of Columbia — at the ex- 
pense of the District. 

Senator Works. I suppose the Government would have no further 
responsibility after his discharge than it would have toward any 
other American citizen. 

The Chairman. Perhaps not; but the disease was incurred in the 
performance of the soldier's duty to the Government and to the peo- 
ple, and, since we do not hesitate to pay a substantial pension to the 
soldiers of the Civil War, there would seem to be no reason why some 
Government obligation does not exist in the case of these men. 

Senator Works. Oh, yes; there would seem to be some moral obli- 
gation, but I meant legally. I call attention to that interstate or in- 
ternational phase of the Government's obligation, because of the ef- 
forts being made — a good many of them — to involve the Government 
in appropriations for expenses which, I think, properly belong to the 
States. We are going a long way now in that direction, because of 
the necessities of the States for financial help from the Government; 
but this question is on quite a different footing, I conceive. 

Dr. Hoffman. In reply to the statement made by the Senator from 
California, I shall, with your permission, put into the record an ex- 
tract from a letter of mine to the president of the Prudential, Mr. 
Forrest F. Dry den, written to him during my stav at Molokai, on 
March 11, 1915 : 

I believe no country is doing more for this unfortunate class (lepers) than 
Hawaii. It is not, however, in my opinion, a local, but a Federal matter. 
With all possible reluctance to see an extension of the Federal health activi- 
ties in this direction, I can not but feel that the United States Government 
should take this entire matter in hand for the mainland and its insular posses- 
sions. Leprosy is a more serious menace than is generally assumed. There is 
more of it on the mainland than appears on the surface on the basis of inade- 
quate statistics. On the mainland the treatment of these unfortunates is often 
brutal in the extreme, where isolated cases can not be well treated under 
present conditions. There is need of the taking over of the leper settlements 
in Louisiana, California, Massachusetts, Hawaii, etc.. by the United States 
Public Health Service — to be controlled by the Federal Government and com- 
pletely maintained at the expense of the Nation. The burden upon the Terri- 
tory of Hawaii is very heavy — out of proportion to its means — and the rapid 
eradication of the disease can not take place under present conditions. I firmly 
believe that we have an interest in the matter, and that we should cooperate 
with the United States Public Health Service toward this end. 

The foregoing extract, Senator, should make it clear that I am 
personally opposed to any unnecessary extension in the direction of 
Government aid in behalf of cases, however worthy, which can be 
properly taken care of by the several States. My own investigations 
into this subject of leprosy, however, have made it clear that the 
problem of control is essentially one of interstate and Federal concern. 

With your permission, I would like to include in the record the 
following statement regarding the 104 lepers who at the present time 
are being cared for at the Louisiana settlement. The number of new 
cases admitted during 1914 was 21. Of the 92 native-born lepers, in 
the Louisiana home 48 gave their birthplace as New Orleans, and the 
remainder came from 25 different parishes. Aside from the 92 born 
in Louisiana, 11 were born in other States of the United States; that 



122 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

is, Florida, Kentucky, Missouri, North Carolina, Pennsylvania, and 
Texas; 12 came from foreign countries, as follows: China, 1; Den- 
mark, 1 ; France, 2 ; Germany. 1 ; Ireland, 2 ; Italy, 2 ; Jamaica, West 
Indies, 1; Mexico, 1; Norway, 1; and for 4 the information could not 
be obtained. 

Senator Works. The conditions in Louisiana are quite different 
from other parts of the country, are they not, Doctor? In other 
places most of the lepers are foreigners, are they not? Take Massa- 
chusetts, for example ? 

Dr. Hoffman. Yes; they are nearly all foreigners. 

Senator Works. And that is true very largely for California, is it 
not? 

Dr. Hoffman. Yes, Senator; all of the details regarding the lepers 
at the San Francisco Isolation Hospital are contained in the list pre- 
\ iously put into the record, according to which only 3 out of 15 lepers 
were native born. 

The Chairman. How is it in New York? 

Dr. Hoffman. I regret to say I have no very definite knowledge 
as regards the lepers apprehended or cared for in New York City ; 
but my recollection is that most of them are foreign born or from 
other States with a record of exposure in the Philippines or the West 
Indies. 

Senator Works. How do you account for that condition? In 
other words, how do you account for the fact that there are so many 
native-born people of Louisiana that are afflicted with the disease? 

Dr. Hoffman. Leprosy has been endemic in Louisiana for more 
than a hundred years. It may possibly have been brought there by 
the Acadians after their expulsion from Nova Scotia. It is certainly 
a curious coincidence that the disease should be endemic among the 
French Canadians in the Maritime Provinces and also among the 
French Acadians in Louisiana. They are. as a rule, but not always, 
of the poorest of the French element, and they usually come from 
sparsely settled sections in the Gulf parishes. It is not often that 
a case occurs among the more advanced class of people, but occasion- 
ally such cases are met with. 

Senator Works. Is that accounted for in any way by experts on 
the subject? 

Dr. Hoffman. I would not like to commit myself to any medical 
theories, for as yet there is not, broadly speaking, a concensus of 
qualified opinion. It would seem, however, that economic well-being, 
material prosperity, and attention to the requirements of a rational 
personal hygiene are the safest precautions against leprosy. Abso- 
lute bodily cleanliness, a nutritious diet, and a healthy mode of life 
otherwise seem to afford adequate protection to the white attendants 
who are in daily, and even hourly, contact with lepers in all stages of 
the disease. 

I have here a very interesting document which you may wish to 
include in the record. It is the original examination paper used in 
Hawaii in connection with the examination of lepers for final com- 
mitment to the settlement. It is a document which reflects the 
humanity as well as the high order of intelligence of the Territorial 
government in thoroughly protecting anyone against possible errors 
in the medical and bacteriological diagnosis of the disease. The ex- 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 123 

amination of the suspected person is invariably made by three physi- 
cians and these must agree in their findings, and in addition thereto 
the bacteriological evidence must be conclusive. 

The Chairman. We will include that paper. 

(The paper referred to is here printed in full, as follows:) 

Original examination record of Board of Health of Hawaii. 



1. Name, . 

2. Nationality, . Sex, . Age, . Civil state, . 

(Classify according to predominant strain.) 

3. Hawaiian blood, . Place of birth, . 

(State as nearly as possible what proportion.) 

4. Occupation, . 

(State nature of present and former occupations and time and place of such 
occupations. ) 

9. Present and former residences, . 

(State particularly places and length of residence in the different localities 
in the Hawaiian Islands.) 

16. Date of arrival in Hawaiian Islands, . 

FAMILY HISTORY. 

17. Father, . 

18- Name, {^ g Leper {^ Age , . 

Nationality, . 

(Predominant strain.) 

19. Residence, . Occupation, . 

(If dead, state former occupation.) 

20. Additional facts, . 

(State whether brothers or sisters or father or mother of father were lepers, 
giving their names and as full information in regard thereto as possible, and 
association of this patient therewith.) 

26. Mother, . 

27. Name, fe™ Leper {Jf Age, . 



Living. ^ CiJ ~ \No. 

Nationality, . 

(Predominant, strain.) 

28. Residence, . Maiden name, . 

29. Additional facts, . 

(State whether brothers or sisters or father or mother of mother were lepers, 
giving their names and as full information as possible in regard thereto and 
association of this patient therewith.) 

34. Brothers, . 

(Mark those not living with a cross thus, X.) 

35. Name, . Age, . Married* (give maiden name of 

wife). Residence, 



43. Additional facts, ■ — . 

( State full particulars such as would be required of this patient as to those of 
the above who have been or are lepers.) 

54. Sisters, . 

(Mark those not living with a cross thus, X.) 

55. Name, ■ . Age, - — . Married, (give maiden name of 

wife). Residence, 



63. Additional facts, . 

(State full particulars such as would be required of this patient as to those 
of the above who have been or are lepers. ) 

74. Wife. Maiden name, {dSvcI^ 

75. Husband. Name, — {dS^' 

76. Residence, . Date of marriage, . 

77. Married more than once, . 

(If married more than once, give names of husbands, or wives' maiden names 
and dates of marriages.) 



124 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

79. Additional facts, 



(If any wife is or has been a leper, go fully into the facts and insert them 
here, stating when first symptoms appeared, etc.) 

91. Children, . 

(Mark those not living with a cross, thus, x.) 

92. Name, . Age, . Sex, . Married, (name of hus- 
band, or wife's maiden name). Residence, . 

100. Additional facts, . 

(State particulars, such as would be required of this patient in regard to 
those above who have been or are lepers. Also set forth the children of the 
above and all particulars in regard to them, and if such children have been or 
are lepers, follow the same course in regard to them as indicated in case of one 
having leprosy.) 

11G. Any intimate associates, past or present, leprous? — — , 

PERSONAL HISTORY. 

124. Date of earliest symptom, . 

125. Character of earliest symptom, . 

126. Location of earliest symptom, . 

127. Subsequent progress, . 

CLINICAL HISTORY. 



132. Face, . Back, 

133. Eyebrows, 

134. Ears, 

135. Nose, 

136. Facial paralysis, — — . Thigh, 

137. Neck, . Leg, . 

138. Chest, . Feet, . 

139. Abdomen, . Toes, . 



140. 
143. 



BACTERIOLOGICAL FINDINGS. 



-, M. D., 



Bacteriologist, Board of Health. 

DIAGNOSIS. 



145. Type: Tubercular. Anaesthetic. Mixed. 

(Underline type.) 

147. Date admitted to Kalihi Hospital, 



148. Date transferred to Leper Settlement, Molokal, . 

, M. D., 

Medical Superintendent. 
Dated : Kalihi Hospital the day of , 19—. 

LIFE HISTORY. 

Note. — This should be gone into fully and in detail, tracing every association 
and incident in the life of the patient which has any bearing on the pathological 
side of his case. While every effort is expected to be made to secure this as 
soon as the patient is admitted to the hospital, it is appreciated that there are 
limitations on the information which may be secured in the inception of the 
treatment of the patient. It is expected, therefore, that further information 
will be secured and added hereto as treatment at the hospital progresses and 
will be added on the other blank sheets furnished for the purpose. 

, M. D., 

Medical Superintendent. 

Dated : Kalihi Hospital, the day of , 19 — . 

Dr. Hoffman. I would also like to put into the record a statement 
with regard to the truly remarkable decrease of leprosy in Norway 
since segregation was introduced and made relatively effective. In 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 125 

1856 the number of lepers in Norway was 2,858, which by 1910 had 
progressively decreased to 323. In proportion to population the 
leprosy rate in 1856 was 191 per 100,000 against only 13.5 in 1910. 

The Chairman. To what do you ascribe that decrease? 

Dr. Hoffman. Largety, if not entirely, to segregation. In the 
opinion of all the authorities on leprosy which I have knowledge of, 
segregation is the only plausible explanation. In Iceland where the 
disease had been increasing for a number of years it was also ulti- 
mately brought under control by segregation and the Government 
leprosarium at Reykjavik is considered a model institution, which 
reflects the attained civilization of that remote island possession or 
Denmark. 

The Chairman. Does the general rule seem to be that where you 
do not have segregation the disease gradually increases and that 
where you have segregation it gradually decreases? 

Dr. Hoffman. Yes, Senator ; that, broadly speaking, would appear 
to be the case. 

Senator Works. What is the effect of climate upon leprosy? 

Dr. Hoffman. Climate per se, as far as I know, has no direct re- 
lation to leprosy at all. The disease occurs from the tropics to the 
arctic regions. More than half a thousand years ago it prevailed ex- 
tensively over the entire European continent. Under tropical condi- 
tions, where life is so much easier and where the people are more 
apt to ignore hygienic precautions it can readily be understood why 
leprosy should be more common and less easily eradicated than in 
temperate zones. The food among primitive people is also, as a rule, 
often wanting in variety and nutritious qualities. It is claimed by 
some that a fish diet predisposes to leprosy, but this would seem to 
be extremely doubtful. Leprosy is not met with in Newfoundland 
or Labrador, although the people there live almost exclusively on a 
fish diet. A few sporadic cases have occurred in Alaska, possibly 
introduced from the Orient. 

The Chairman. How about race? 

Dr. Hoffman. Race would seem to have an important bearing 
upon the relative frequency of leprosy among the different types of 
mankind. I have here a statement of the mortality from leprosy in 
Hawaii by race, based upon the statistics for 1911-1914. According 
to this information the leprosy mortality rate was 15.2 per 10.000 of 
population for pure Hawaiians, 1 for Part Hawaiians, 0.8 for Portu- 
guese, 1.5 for the Chinese, 0.1 for Japanese, and 0.2 for all others, 
which, of course, includes all Caucasians other than Portuguese. For 
all races combined the leprosy mortality rate was 2.5 per 10,000. In 
the aggregate during this period there were 157 deaths from leprosy, 
and of this number 131 were pure Hawaiians, 4 Part Hawaiians, 6 
Portuguese, 11 Chinese, 3 Japanese, and only 2 were of some other 
Caucasian race than Portuguese. 

Senator Works. I think it is generally believed, however, that the 
disease is more prevalent in tropical climates. 

Dr. Hoffman. Yes, Senator; that is unquestionably true, but the 
reason is not, in all probability, the climate, but the fact that the 
type of people chiefly predisposed to leprosy on account of their 
habits or mode of life are so much more numerous in tropical regions 
than among our more active, industrious, and robust population. As 
33993°— S. Rept. 306, 64-1 9 



126 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

I have just pointed out, in Hawaii leprosy is almost exclusively lim- 
ited to Hawaiians, part Hawaiians, and Chinese. 

The Chairman. Have you any statistics as regards the white and 
negro races in Louisiana? 

Dr. Hoffman. Yes, Senator; in proportion to population there is 
less leprosy in Louisiana among the negroes than among the whites. 

The Chairman. There is less among the negroes ? 

Dr. Hoffman. Yes, Senator; there is less among the negroes in 
proportion to population than among the whites. 

The Chairman. How do you account for that? 

Dr. Hoffman. I can not account for it, except on the ground that 
the foci of the disease has for many years been chiefly among the 
natives of French extraction, who have very little, if any, direct con- 
tact with the negro population in those particular parishes in which 
the disease is most common, and in which, in fact, the proportion of 
negroes to the total population is relatively small. 

According to the official statistics for the Leper Home the number 
of inmates as of April 16, 1914, has been 70.2 per million of white 
population and 20.3 per million of colored population. 

The Chairman. You might give us the actual numbers if you can 
do so. 

Dr. Hoffman. During the period 1912-1914 — that is, the last bien- 
nial period for which the information has been published — there 
were 60 white male lepers admitted and 34 white female lepers, or a 
total of 94 white persons, against 14 colored male lepers and 9 col- 
ored female lepers, or a total of 23 admissions of persons of color. 

Senator Works. What is the proportion of population as between 
colored and white races in Louisiana ? 

Dr. Hoffman. The proportion of white population is 56.8 per- 
cent and the proportion of white lepers admitted during 1912-1914 
is 80.3 per cent. The proportion of colored population is 43.2 per cent 
and the proportion of colored lepers admitted during 1912-1914 is 
19.7 per cent. It is therefore quite clear that the leprosy rate among 
the negroes is less than it is among the whites. 

In this connection, Mr. Chairman, your committee may be inter- 
ested in the following statement with reference to the comparative 
leper rate for this and other countries. On the basis of the official 
returns for the year 1914 the leper rate per 100,000 of population was 
4.9 for Louisiana, 48.6 for the Philippine Islands, 122.3 for British 
Guiana, and 301.2 for the Territory of Hawaii. 

The Chairman. What relation is there between leprosy and in- 
sanity, if any, Doctor? 

Dr. Hoffman. Apparently there is no such relation, although 
there are a few demented persons at all the leper settlements of 
which I have knowledge. Naturally, as the terminal stage of the 
disease is approached, the mind gives way with the body. Suicide 
seems to be very rare among lepers, for in the experience at Molokai, 
during a long period of years, there have been very few cases of self- 
murder. 

The Chairman (interposing). Practically, then, there is no defi- 
nite relation between leprosy and insanity, as far as you know ? 

Dr. Hoffman. Not as far as I know of; but as I have just said, 
naturally, as the lepers attain old age. they become more helpless 
and occasionally reach the stage of senile dementia. 






TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 127 

The Chairman. Being a statistician, Doctor, I suppose you have 
found considerable trouble about getting statistics of leprosy in the 
United States, have you not? 

Dr.. Hoffman. We, of course, have difficulty in obtaining all the 
required information for a thorough and conclusive study of the 
subject. As far as I know, a complete analysis of the data either 
for Hawaii or Louisiana has not thus far been attempted. For the 
United States our information is quite inconclusive, because of the 
fact that in many of the States the disease is not reportable. As I 
may have said before, according to official reports made to me, there 
are about 150 lepers known to the health authorities of this country, 
and about two-thirds of this number are at the Leper Home in 
Louisiana. 

The Chairman. Will you make your statement a little more ex- 
plicit as regards the difficulties in the way of securing a complete 
statement of the number of lepers in the United States, excluding 
our noncontiguous possessions? 

Dr. Hoffman. In the first place, Senator, I am of the opinion 
that the diagnosis of the disease is frequently erroneous. Leprosy 
is so rare that many physicians never see a case during their entire 
experience. When met with in isolated cases a final diagnosis is 
necessarily made with much reluctance. A physician this morning 
testified that cases frequently come to a hospital where they are 
disagnosed superficially as skin diseases of one kind or another. 
Even more frequently the disease is confused with syphilis, and in 
some cases with erysipelas. As the disease approaches a terminal 
stage and the patient grows worse the disagnosis is, of course, made 
with less difficulty. 

In this connection I desire to refer back to my previous statement 
as regards 80 cases of leprosy reported by skin specialists for the 
city of Chicago. I am informed by Dr. John Dell Robertson, com- 
missioner of health, as follows [reading] : 

I feel safe in saying that nearly all skin specialists have seen cases of leprosy, 
and that it is their common experience that these cases come for treatment 
until the patients are told the true nature of their disease. Upon receiving 
this information they usually stop coming to the specialist or disappear, and 
probably in time show up at some other place. When this habit of lepers is 
taken into consideration the large number of supposed cases reported from 
time to time in large cities may dwindle considerably on account of the dupli- 
cation resulting from one patient being treated from time to time in a number 
of dispensaries. During the last two or three years we have had from one 
to two lepers in our isolation hospital. Cases have also been discovered in our 
suburbs, and attempts have been made to isolate the same. 

In view of the foregoing explanation I add the concluding sentence. 
of the letter by Commissioner Robertson [reading] : 

We therefore welcome the establishment of a national leprosarium in accord- 
ance with the terms of Senate bill 4086. 

The Chairman. Have we any means or special statutory methods 
with regard to the collection of statistics of leprosy in the United 
States? 

Dr. Hoffman. No, Senator; the only method available to us as 
regards a reasonably complete census of leprosy for the mainland 
of the United States is for the United States Public Health Service 
to enlist the cooperation of the entire medical profession and request 



128 TREATMENT OF PERSONS .AFFLICTED WITH LEPROSY. 

reports of leprosy cases under treatment, with such qualifications, of 
course, as may be necessary in very doubtful or merely suspected 
cases. 

Senator Works. Is not an effort made by the United States Census 
Bureau ? 

Dr. Hoffman. The Division of Vital Statistics of the United 
States Census Bureau collects vital statistics only for the so-called 
registration area, which includes about two-thirds of the total popu- 
lation, and less than one-half of the entire area of the country. It so 
happens that the States for which no vital statistics are at present 
being published are also the States in which leprosy is most common. 
That, of course, is chiefly true for Louisiana. The mortality returns 
for the registration area, for illustration, do not include the returns 
for the Louisiana Leper Home. 

The Chairman. You spoke earlier in your evidence of the occa- 
sional inhumanity to lepers apprehended while in interstate transit, 
and you have heard what Dr. Engman has said about this important 
matter. Do you believe that for similar reasons there are a good 
many cases of leprosy in the United States with regard to which the 
facts are withheld on account of the possibility of inhuman or other- 
wise improper treatment? 

Dr. Hoffman. I should think so, Senator, because the individual 
cases which I have taken note of during the last 20 years prove con- 
clusively that there is a most unreasonable attitude on the part of 
the public, needlessly apprehensive as to the possibility of infection. 
In quite a number of cases lepers have been hounded from one part 
of the country to the other and doctors have time and again been 
afraid to make a positive diagnosis for fear of getting themselves 
and their patients into trouble. In other words, a positive diagnosis 
of leprosy is only made when there is obviously no alternative ; but 
where there is the least suspicion of doubt there is naturally reluc- 
tance to subject or expose the patient to the certainty of more or less 
inhuman and otherwise wrongful treatment in the absence of ade- 
quate provision for segregation and institutional care. 

The Chairman. I wish, Doctor, you would give us some actual 
illustrations. 

Dr. Hoffman. May I read to you a statement in reply to your 
question, Senator? 

The Chairman. Certainly. 

Dr. Hoffman. The following is from an address which I delivered 
last year before the American Academy of Medicine on the leprosy 
problem in San Francisco [reading] : 

The present hazardous and more or less superficial and inhuman treatment 
has been a matter of public record for more than 20 years. Cases after cases 
have temporarily attracted public attention, but being few in Dumber and 
often far between they have not resulted in the development of a sound 
national sentiment favorable to the national control of the disease under 
suitable conditions of segregation. For illustration : There was a case of 
leprosy in Columbus, Ohio, in 1898, which subsequently resulted in another 
case, the origin of the disease being traced to the father, who, it was claimed. 
had contracted leprosy during the Civil War. 

In 1899 Dr. Herbert C. Moffatt exhibited a leper in the city of New York 
who had probably contracted the disease in Cuba or among the Aleutian Indians 
of Alaska. The patient in this case was himself a physician. 

In 1906 a case occurred in West Virginia which attracted much attention 
on account of the wanderings or interstate movements of the leper, which 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 129 

should early and promptly haye required Federal interference. The case was 
found in a remote section of the State, and it was reported at the time that 
" the public of the district where the leper is now sojourning was panic- 
stricken, and he has been much neglected, but the county has now taken him 
in charge and will, it is said, build him a house and will otherwise provide 
for him." It would be difficult to conceive of a less satisfactory method regard- 
ing both the leper and the public at large. The treatment of leprosy requires 
special attention and a thorough understanding of the symptoms and the 
course of the disease, which are not likely to be met with in the case of the 
ordinary practitioner, least of all in a remote section of a State like West 
Virginia. Even in Washington, D. C, when the Early case first came under 
observation the method of providing for his care was crude, but the public 
alarm was not unjustified. It was reported at the time that the street cars 
in which he was thought to have traveled were thoroughly disinfected and 
every house in which he was known to have been was fumigated. 

It may be said in this connection that such precautions merely 
indicate how the disease may be spread in the course of time through 
entirely unsuspected channels of infection. Even after the positive 
diagnosis has been made the average duration of the disease is from 
8 to 10 years. In some cases lepers have lived for 20 and even 30 
years under proper treatment. How long a period intervenes be- 
tween the first infection and the first positive diagnosis is at present 
unknown. 

In continuation I quote from the address referred to [reading] : 

Some six years ago the United States Army had an isolated leper, who was 
taken care of at Fort Screven, near Savannah, Ga. The leper was a first 
sergeant, and a cottage was built for him, where, as far as practicable, he 
had every necessary medical attention. The sergeant submitted with patience 
to every treatment, but under such conditions of isolation it is readily con- 
ceivable that the suffering must have been needlessly greater and the chance 
of a cure much less than if adequate provision had been made for this patient 
in a modern leprosarium. 

In 1910 a woman leper was found in the city of New York who had come 
from Baltimore two weeks previous, where the board of health had been 
making strenuous efforts for her apprehension and isolation. As reported in 
the New York newspapers at the time, sequestration or isolation would not 
be required in her case in the city of New York under the assumption that 
" the chances of communicating the disease are so slight as to make isolation 
unnecessary." 

In other words, because of easy-going methods not in conformity 
to modern scientific theories regarding leprosy contagion New York 
City attracts apparently lepers from other parts of the country, and 
there can be no serious doubt about this being the case. [Eeading :] 

Perhaps the most interesting recent case occurred in Pawtucket, R. I., where 
a 15-year-old schoolboy was first discovered to be a leper in one of the isolation 
wards of the Massachusetts General Hospital — where he had gone for treat- 
ment. As reported in the newspapers at the time, " when the news of the case 
became known in Pawtucket, it caused tremendous alarm, especially in families 
whose children were attending the same school." The home of the boy was 
surrounded by policemen, and complaint was made by the school-teacher that 
she was being shunned on account of her possible contact with the boy, who 
was subsequently being taken care of by the Rhode Island authorities. 

In the same year (1911) a case of leprosy was discovered in Pittsburgh. The 
man, who was found afflicted with leprosy, was a Chinese bookkeeper in a 
Chinese store. He was taken to the municipal hospital and placed tempo- 
rarily in a tent until a separate house could be erected for him. 

Also in 1911 a case was discovered in Minneapolis, where a leper was found 
to have suffered from the disease for 12 years. The case was not diagnosed as 
leprosy until the man died — when an autopsy was performed. At about the 
same time a case of leprosy was discovered in Jersey City, N. J., which 
terminated in death, following isolation or segregation of only a few weeks 
preceding. 



130 TREATMENT OF PEESONS AFFLICTED WITH LEPROSY. 

In Paterson, N. J., there was discovered a Chinaman leper, ill in a laundry, 
who died a few days later at the Isolation Hospital. It was reported at the 
time that he was supposed to be one of two lepers who had escaped from the 
city quarantine station at North Brother Island. 

Recalling that the Grable case had its apparent beginning in Idaho, 
the following case is of special interest [reading] : 

A family of lepers was found on a ranch in Idaho, consising of the father, the 
mother, and the two children. The father had been in Honolulu some years 
before, and, no doubt, contracted the disease in the islands. 

At about the same time a case of leprosy was discovered in Fort Wayne, 
Ind. — a Syrian woman who had but three weeks before come from Hawaii, 
where she had contracted the disease. 

There is also on record the case of a young man, 18 years of age, who for 
four years was afflicted with the tubercular form of leprosy, and who was taken 
eare of in Brooklyn Hospital for Contagious Diseases. The boy was the son 
of a tobacco merchant living at Key West, Fla., where he no doubt contracted 
the disease, possibly through West Indian sources. 

A noted case from an interstate point of view was that of a Greek leper 
found in Chicago, who had escaped from quarantine in Salt Lake City, but who 
ultimately succeeded in passing through to New York. 

Finally, mention may be made of the case of a widow of a general in the 
United States Army, who died from leprosy at the county hospital at Los 
Angeles. She had formerly been living in Arizona and other sections of the 
United States. 

As regards any and all of these cases I have had to rely upon general news- 
paper information, but I have no reasons for questioning that, in the main, the 
statements are in accordance with the facts. 

Other cases could be mentioned to further emphasize the early conclusion 
that isolated instances of leprosy suggest the inadequacy and danger of any 
and all methods of treatment other than complete segregation in a leprosarium 
under either Federal or State control. The time has passed for academic 
discussion, and the time for definite action has come. The evidence is over- 
whelming that leprosy exists in this country to a much larger extent than 
is generally assumed to be the case, and that the risk of the introduction of the 
disease from South America, the West Indies, the Philippines, and the Orient 
must be considered as much more of a menace at the present time than in former 
years. A carefully considered plan for national segregation, treatment, and 
control has been for several years before Congress, and a new measure likely 
to be brought forward in support of this proposition is entitled to public confi- 
dence and active support. The early enactment of such a measure is called for 
by the highest considerations of public policy. 

All of the cases which have been cited and many others which are 
a matter of record have a more or less obvious interstate and inter- 
national aspect, and precisely illustrate the point that adequate 
treatment was not, as a rule, furnished, or feasible, and that, aside 
therefrom, lepers have frequently been treated in an inhuman and 
inconsiderate manner because of the unjustified apprehension on the 
part of the public. 

The Chairman. Have you known of cases where the treatment 
was really inhuman? I do not mean where there was intentional 
nnkindness, but where the leper was treated with neglect or needless 
exposure on account of fright and danger to the public. 

Dr. Hoffman. In many of the cases quoted, but especially the one 
in West Virginia and the one in Rhode Island, the patients were 
certainly subjected to much indignity and needless terror. In the 
notorious Grable case the man was certainly subjected to more or less 
mental stress and physical strain, because he was not wanted any- 
where, and to provide for him at a Federal quarantine was found 
impracticable, even though the Federal authorities were quite willing 
to do what was necessary. I have time and again been told in 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 131 

confidence of very trying cases, of forcible attempts at deportation, 
or of interstate transportation in the case of lepers apprehended in 
one section of the country but properly chargeable as regards their 
care and treatment to another section. 

The Chairman. Such unfortunate occurrences would, of course, 
be impossible if there were a national leprosarium to which these 
people could be sent. There would then be no inducement to do 
these inhuman things. 

Dr. Hoffman. I strongly share your views, Senator, because it 
would seem only reasonable that this conclusion would follow. In 
Hawaii there are no more harrowing scenes; and in many cases the 
lepers of their own accord go to the receiving station just outside of 
Honolulu for preliminary examination and detention. I saw a boy 
there who came of his own free will to request an examination. In 
the earlier years, when the accommodations at Molokai were very 
poor and when much needless force was used in separating husbands 
from wives and parents from children, the lepers were naturally 
reluctant to go to Molokai; but that condition is absolutely of the 
past. Under the humane and rational rules which govern the settle- 
ment, married lepers at Molokai are permitted to continue living 
together, even though one of the parties may be, and often is, a 
" clean " person. When a child is born of such marriages the child 
is at once taken from the mother and removed to a children's home 
(in the settlement), where it is cared for from one to two years, 
until removed to an institution in Honolulu. The leprous mother 
can see the child as often as desired while at the settlement, but she 
can not come in contact with the same, and afterwards the child can 
visit the mother and see the same at the visitors house, but the two 
can not touch each other or come in personal contact in any way. 
By means of this precaution children of lepers have been practically 
protected in nearly all cases against the risk of leprosy. At the 
Louisiana settlement the male lepers live apart from the female 
lepers, which the experience at Molokai has shown is neither desirable 
nor necessary. I am of the opinion that the less done to make the set- 
tlement resemble a prison or an institution the better. At Molokai the 
general appearance of the settlement is that of a pleasant country vil- 
lage, with churches, stores, schools, etc., and the lepers therefore feel 
as near at home as it is possible for them to do. 

What we are most urgently in need of in this country is a national 
sentiment on the subject of leprosy, which is a disease essentially 
different from practically every other affliction of mankind. We have 
to make the leper realize that when he finds himself afflicted with this 
disease the only adequate treatment and proper care can be had in a 
National or State leprosarium; in fact, there is no difficulty in this 
respect when such an institution is available, as is the case in Louisi- 
ana, at San Francisco, and at Penikese Island, Mass. Lepers vol- 
untarily go to these institutions because they know full well that 
they can not receive the skillful treatment and humane nursing and 
care at their homes or in some isolated room of a county hospital or 
poorhouse. 

During my stay at Molokai the conviction was forced upon me 
that much harm had been done to the cause of leper care by the 
exaggerated stories of Father Damien and the alleged horrors of the 
disease. Every now and then the newspapers announce the reso- 



132 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

lution of some priest or mm or lay brother or sister to go to Molokai 
as " a living grave." All this is a wrongful perversion of the public 
understanding of the facts. Any one of the attendants at Molokai 
can go to Honolulu if he cares to, or to the mainland, of his own 
free will and accord. Dr. McCoy, who is in this room, spent many 
months at Molokai, going forward and backward between the settle- 
ment and Honolulu. During his whole stay at the Kalihi Hospital 
he was never interfered with on his return to the city. There is no 
particular amount of extreme self-sacrifice or personal heroism in- 
volved in the nursing of lepers, other than the very remote but, of 
course, frightful risk of infection which is necessarily incurred. Of 
the three white men who have contracted the disease at the Molokai 
settlement in the care of lepers, one was Father Damien, the second 
a Brother of the Order of St. Francis, who possibly may have been 
a leper on admission, and the third was a Belgian, still living, but 
probably certain to die of the disease. There are at the present time 
some 51 well persons living at the settlement, including 13 persons 
connected with the United States lighthouse, including wives and 
children; 5 Sisters of the Order of St. Francis, 2 priests, 2 lay 
brothers, and other nurses and servants, as well as the superintendent, 
the resident physician, and his wife and children. 

At the Bishop Home, under the care of the sisters, are 58 leper 
women, yet none of the sisters in the entire experience of the settle- 
ment has contracted the disease. The same conclusion applies to 
the Louisiana Leper Home, and to the Lazaretto at Tracadie. The 
plain truth about the matter is that these sisters, as well as all the 
other white attendants in charge, live clean, active, and truly Christian 
lives. Nowhere have T seen more of the genuine spirit of Christianity, 
of self-sacrificing charity, and true goodness of heart than among 
the Catholic sisters at the leper settlement in Louisiana and among 
the physicians, sisters, and attendants at Molokai. The same con- 
clusion applies to Dr. A. A. O'Neill, in charge of the Isolation 
Hospital of San Francisco, who has only 1 helper to care for 15 
lepers, some of whom are in the terminal and absolutely helpless 
stage of the disease. All of these, personally known to me, and count- 
less others connected with leper settlements throughout the world 
perform a truly Christian service in behalf of a most afflicted portion 
of mankind. 

The Chairman. You think, then, Doctor, that a great deal of the 
public horror and fright regarding leprosy is illfounded? 

Dr. Hoffman. In a large measure, Senator, this is true. Per- 
sonally I have never had any fear of the disease; nor, for that matter, 
of contagion in any other disease. I certainly have decidedly less 
fear of leprosy than of smallpox, scarlet fever, tuberculosis, or 
typhoid fever. No very special precautions are being taken at 
Molokai, and yet, as I have said before, there have been no cases of 
leprosy directly traceable among the attendants, other than the 
three cases referred to, which, in their nature, were quite exceptional. 
At the Louisiana Leper Home they take more precautions, and I 
can not but feel that this is advisable. No very special precautions 
are employed at San Francisco ; but at all of these institutions every- 
thing reasonable is done to protect the attendants and the public. 
No leper, for illustration, at Molokai ever enters the house of a well 
person; no leper ever touches a well person; no article of food, either 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 133 

used by lepers or by well persons, is ever handled or manipulated by 
a leper. At the San Francisco Isolation Hospital an almost ideal 
arrangement has been evolved by Dr. O'Neill, which is well worthy 
of study on the part of those who have to maintain leper settlements 
in connection with other institutions. Each and every one of the 
attendants, of course, incurs a risk, and the same applies to those 
who make a scientific study of the disease. The risk, however, is 
simply a part of life, for without it there would be no progress in 
either science or humanity. 

The Chairman. Do you mean to say, then, that it is extremely 
rare for an attendant at a leprosarium to contract the disease ? 

Dr. Hoffman. Yes, Senator ; and I may say that I have thoroughly 
gone into this matter at different times. The superintendent of the 
settlement at Molokai, Mr. J. D. McVeigh, has been at the settlement 
between 15 and 20 years, and Dr. William J. Goodhue, the attendant 
physician, has been there about the same time. Sister Mary Ann, 
who is the sister superior, has been there, I believe, 23 years ; Brother 
Dutton, in charge of the Baldwin Home, has been there 20 years or 
more. At the Louisiana settlement, Sister Benedictine has been in 
charge for quite a number of years, while Dr. Ralph Hopkins and Dr. 
Isadore Dyer have had the institution under their immediate supervi- 
sion, including weekly visits, for a long time. 

The Chairman. All of these, you say, are in constant contact with 
the lepers? 

Dr. Hoffman. Yes ; constantly, in, of course, a limited sense of the 
term. The Sisters, however, perform, if necessary, the most menial 
service for the lepers, and they are most exposed. In the terminal 
stage the lepers are absolutely helpless, and the patient reaches a 
point where the use of the limbs is entirely lost; where the sight is 
gone, etc. Such a condition may last for months, and no words of 
mine can. do justice to the sublime service rendered by the Sisters 
and others to these unfortunates during the last and most trying 
stage of the disease. 

The Chairman. In writing to the various State health authori- 
ties, as testified by you a while ago, did you send a copy of the bill 
along with your letter, or give the substance of the bill ? 

Dr. Hoffman. No, Senator ; my letters of inquiry were sent out in 
July last year, or long before this bill had been introduced. 

The Chairman. But did you not refer to the urgency of a national 
leprosarium ? 

Dr. Hoffman. Yes, Senator ; the title of my San Francisco address, 
in fact, was "Leprosy as a national problem." If the committee de- 
sires, I will insert it in the record. 

(The matter referred to is here printed, in full, as follows:) 

LEPROSY AS A NATIONAL PROBLEM. 

At the Second International Conference on Leprosy, held in Bergen, Norway, 
August 16-19, 1909, the following-named countries were represented by official 
delegates : Argentine Republic, Belgium, Bulgaria, China, Cuba, Denmark, Eng- 
land, France, Holland, Italy, Japan, Portugal, Russia, Spain, Sweden, Germany, 
Egypt, Austria-Hungary, and the United States of America. The enumeration of 
these countries is sufficient to emphasize the world-wide aspects of the leprosy 
problem and its significance to the United States. There are, unfortunately, no 
trustworthy and complete statistics regarding the extent of leprosy throughout the 
world, and not even for the United States are the data complete and sufficient to 



134 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

warrant definite conclusions. On the occasion of the congress referred to the num- 
ber of lepers on the mainland of the United States was estimated at 146; for 
the Hawaiian Islands, 764; for Porto Rico, 17; for the Island of Guam, 19; 
for the Philippine Islands, 2,330 ; and for the Panama Canal Zone, 7 ; a total of 
3,283 for the United States and its noncontiguous possessions. There are strong 
reasons for believing that the number of lepers on the mainland is much larger 
than the number returned by the leper census for the year referred to. No 
thorough inquiry has ever been made to ascertain all of the lepers even in the 
State of Louisiana, and it is a safe assumption that not half the true number 
are actually being taken care of at the leper home of that State. 

Outside of the mainland of North America leprosy in the Western Hemi- 
sphere in 1909 was distributed, in part, as follows : In Cuba there were 1,297 
cases; United States of Colombia, 4,152; Argentine Republic, 12,000; and the 
Island of Jamaica, 115. For all other islands of the West Indies and the coun- 
tries of South and Central America the information was not obtainable. 

In 1912 a further effort was made to determine the number of lepers in the 
United States and its noncontiguous possessions. The total number of new 
cases reported during the calendar year 1911 was 1,217, and the number of cases 
reported as present on January 1, 1912, was 3,478. Of this number 146 were 
reported for the mainland, 696 for Hawaii, 2,754 for the Philippine Islands, 
and 28 for Porto Rico. Cases were reported for the several States as follows : 
Arizona, 1 ; California, 23 ; Connecticut, 1 ; Florida, 2 ; Indiana, 1 ; Kansas, 1 ; 
Louisiana, 71 ; Massachusetts, 13 ; Michigan, 1 ; Minnesota, 18 ; New York, 5 ; 
North Dakota, 1 ; Pennsylvania, 3 ; Rhode Island, 1 ; Utah, 1 ; Washington, 2 ; 
and Wisconsin, 1. 

The ascertainment of the extent of leprosy throughout the United States 
had been by means of a circular letter of inquiry, sent out by the Surgeon 
General of the United States Public Health Service, to the health authorities of 
the several States. There are no means at the present time, however, by which 
the true extent of leprosy can be determined with absolute accuracy. It may 
properly be questioned whether more than a very small fraction of the physi- 
cians throughout the country are qualified to diagnose a case of leprosy in the 
initial stages. It is often difficult to even diagnose a case after the disease 
has made considerable progress. The disease is reportable in only 19 States, 
as follows: Alabama, California, Connecticut, District of Columbia, Florida, 
Idaho, Illinois, Indiana, Iowa, Massachusetts, Nebraska, New Jersey, New 
York, Oregon, Pennsylvania, South Carolina, Utah, Washington, and Wisconsin. 
The disease is possibly reportable also in Michigan. It is apparently not re- 
portable in the most important State, and that is Louisiana. Since only the 
city of New Orleans is within the registration area, deaths from leprosy through- 
out the remainder of Louisiana are not at present a matter of record with the 
Division of Vital Statistics of the Census Bureau. 

The number of deaths from leprosy in the United States registration area 
in 1912 was 11, and in 1913 only 6. The mortality rate per 1,000,000 of popu- 
lation was 0.18 for 1912 and 0.09 for 1913. The largest number of known 
lepers on the mainland is in the State of Louisiana, where for a number of 
years segregation has been practiced and where the known lepers are taken 
care of at the leper home at Indian Camp plantation. For the last fiscal year 
the number of patients of record was 87 and the number of new patients re- 
ceived during the previous year was 25. 

There has been no comprehensive statistical investigation of the frequency of 
leprosy throughout the world, but some exceedingly suggestive data are avail- 
able for the countries with which the United States are most concerned. 

In the registration area, which comprehends about 65 per cent of the total 
population, there were 95 deaths from leprosy during the period 1900-1913, 
equivalent to a mortality rate of 0.15 per 1,000,000 of population. Considering 
that each and every death represents a case more or less a menace as a foci 
of the disease, and furthermore that the statement is exclusive of the deaths 
at the Louisiana Leper Home, it needs no further argument to sustain the con- 
viction that the disease requires to be given more serious public consideration. 

It is true, of course, that at present the disease is of very limited extent in 
the United States. Even in Louisiana, where leprosy has been endemic for 
more than 100 years, the comparative leprosy frequency is only 4.9 per 100.000 
of population, compared with 48.6 for the Philippine Islands, 122.3 for British 
Guiana, and 301.2 for the Territory of Hawaii. According to the last official 
report there were 87 lepers at the Louisiana Leper Home, equivalent to a rate 
of 4.9 per 100,000 of population. It is a conservative estimate that there are 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 135 

probably twice that number, if not more, lepers at large, chiefly, however, in 
the remote and sparsely populated extreme southern parishes of the State. Of 
the Louisiana leper patients 51 per cent are white males, 25.9 per cent white 
females, 14 per cent colored males, and 9.1 per cent colored females. The 
average age on admission is about 38 years. The type of the disease in Louis- 
iana is the anesthetic in 36.5 per cent of the cases for the white patients and 
30.3 for the others. The remainder, or 66.8 per cent, is the mixed and nodular 
types combined. 

In Hawaii, at the settlement of Molokai, the present number of lepers is about 
660. Largely as the result of effective segregation the number of lepers in the 
Territory is gradually declining. The number of new cases during the decade 
ending with 1913 was 719, compared with 1,033 new cases during the decade 
ending with 1903. Of 1,060 lepers admitted during 1901-1913, 867, or 81.8 per 
cent, were Hawaiians or Part-Hawaii ans ; 98, or 9.2 per cent, were Chinese, 
Japanese, and Koreans; 52, or 4.9 per cent, were Portuguese; and only 27, or 
2.5 per cent, were Caucasians other than Portuguese, excluding United States 
soldiers and sailors. In 1910 the proportion of Portuguese population of the 
total was 11.6 per cent, which contrasts with only 4.9 per cent of Portuguese 
lepers at the settlement. In the same year the proportion of other Caucasians 
in the population of the Territory was 11.4 per cent, which contrasts with only 
2.5 per cent of lepers at the settlement. It is shown, therefore, that the dis- 
ease is largely confined to the native and oriental populations of Hawaii, and 
that the proportion of cases among them is excessive. Out of 1,060 cases of 
leprosy during the period 1901-1913, 327, or 30.8 per cent, were of the anesthetic 
type. 

As said before, leprosy in Hawaii is relatively and actually on the decline. 
This satisfactory result is primarily to be attributed to the effective plan of 
segregation at Molokai. The conditions of home life, supervision, and treat- 
ment are ideal. The settlement may safely be considered a model of its 
kind, and in addition thereto the Territory maintains a receiving station just 
outside of Honolulu for incipient or other early cases under observation. The 
leper law of Hawaii is both effective and humane. The complete records of 
each case are an admirable illustration of the scientific point of view gov- 
erned by sound medical and humanitarian considerations. As yet, however, no 
comprehensive analysis has been made of the large amount of material in the 
archives of the Territorial board of health. Such an analysis would constitute 
a most valuable contribution toward the scientific study of leprosy, with a 
<lue regard, of course, to all the essential elements of age, sex, race, and pre- 
cise place of origin. 1 

The results achieved in Hawaii find their parallel in Norway. Under a 
policy of effective segregation the leper rate has been gradually reduced from 
191.3 per 100,000 of population in 1856 to 61.9 in 1885 and to 13.5 in 1910. A 
thoroughly digested statistical report is published at quinquennial periods by 
the Government of Norway, amplified by medical and other observations of a 
scientific nature. 2 As a concrete illustration of the remarkable diminution of 
leprosy in Norway, it may be stated that between 1857 and 1875 there were 
3,062 new admissions to the leprosariums, diminishing to 1,108 during the first 
10 years, to 817 during the decade following, to 327 during the 10 years ending 
with 1905, and to only 88 cases during the five years ending with 1910. No such 
comprehensive statistical account has been published regarding leprosy for 
either Louisiana or Hawaii. 

That the lesser numerical extent of the disease on the mainland of the United 
States is not a justification for the neglect to give full publicity to the facts 
is best illustrated by reference to the twentieth report on leprosy in New South 
Wales for the year 1910. On January 1 of that year there were 19 persons 
remaining under detention at the leprosarium, and regarding these a report 
with extremely interesting illustrations, of some 30 pages, is published, and 
amplified by a precise but full account regarding each and every case. The 
report is a most valuable contribution to the scientific study of leprosy and 
deserves to be followed in every detail by the authorities responsible for the 
care of lepers in Louisiana, Hawaii, and elsewhere. Since 1890, when the 
leprosy law providing for compulsory detention became effective, 121 lepers 

1 Studies upon leprosy, by George W. McCoy, M. D., United States Public Health Bulle- 
tins Nos. 61 (July, 1913) and 66 (September, 1914). 

2 Leprosy in Norway (De Spedalske i Norge), 1906-1910. Norway, Official Statistics, vol. 
161; Christiana, 1912. 



136 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

have been admitted, and of this number 55, or 45.5 per cent, have died, 10 have 
been discharged, and 37 have been repatriated (chiefly to China), leaving 19 
remaining on January 1, 1910. The cost of administration for the lepro- 
sarium at Little Bay, New South Wales, for 1910 amounted to £1,635 ($7,957), 
or an average per capita expense of about £90 ($438) per annum. 

For the Territory of Hawaii the amount expended on account of leprosy dur- 
ing the year 1912 was $231,778. The number of lepers cared for during that 
year was 728. The average per capita cost per annum was, therefore, $318. 
The legislature of 1913 appropriated the sum of $412,130 for the care of lepers, 
including permanent improvements at the leper settlements for the two years 
commencing July 1, 1913. It may safely be asserted that no Government in 
the world carries a proportionately heavier burden on account of the care of 
lepers than the Territory of Hawaii. It may also be asserted without fear of 
successful contradiction that nowhere are lepers more effectively and humanely 
taken care of than at the receiving station at Kalihi, near Honolulu, and at the 
permanent settlement at Kalaupapa, on the island of Molokai. 

These observations suggest the question as to what is being done for lepers 
on the mainland. As previously stated, the largest number of lepers in the 
United States at the present time is to be found in the State of Louisiana, but 
for some 20 years they have been more or less segregated at the leper home 
located at Indian Camp plantation about 70 miles from New Orleans. During 
the last decade the conditions at the settlement have been materially improved, 
and the provision which is now made for lepers under segregation in Louisiana 
conforms quite fully to those of Molokai. The settlement has not, however, a 
physician in constant attendance, although the number of lepers, according to 
the last report, was 87. The settlement is visited once a week by a qualified 
leprologist from New Orleans, and at other intervals if necessary. It has 
properly been observed that nothing will draw leper patients at large more 
quickly to a leprosarium " than the knowledge that the best special treatment 
for their trouble can be obtained only at the leper home." Some consideration, 
of course, requires to be given to the class of patients provided for. What is 
suitable and ideal for native Hawaiians, or orientals, is not necessarily the best 
method of accommodation or treatment for French Creoles, or negroes, in 
Louisiana. There is no more grotesque public impression, however, than that 
a leper settlement is a living tomb, or a dreary, hopeless place of residence for 
what are considered, and properly so, perhaps the most unfortunate human 
beings on earth. Modern settlements such as those at Molokai and the leper 
home in Louisiana provide all reasonable comforts and a fair amount of enter- 
tainment, with abundant personal freedom, governed, of course, by restraints 
imperatively called for by broader general considerations. For these reasons 
it is an inhumane and wrongful State policy to permit lepers to be at large, as 
contrary to both their own interests and the larger interests of the community. 
Nor is it advisable to isolate a single leper, for both medical and humane 
reasons. The mere fact of absolute isolation or exceptional consideration is 
detrimental to the best possible treatment. It may seem incredible, but it is 
absolutely true that, in a general way, there is no more cheerful community 
than a large leper settlement such as the one at Molokai or the one in Louisi- 
ana. On the other hand, there is perhaps no more dreary and unfortunate 
position than that of an isolated leper, ostracized from the rest of the com- 
munity and dealt with as an exceptional case. For these reasons, which, of 
course, could be amplified, it is of the greatest practical importance that sev- 
eral Federal leper settlements be established at convenient points throughout 
the country, for the greater comfort and more humane care of these unfor- 
tunates. What has been done in this direction by the State of Massachusetts 
is deserving of the highest praise, although the number of lepers in that case, 
according to the last report, is only 15. The station on Penikese Island is 
conceded to be a model of its kind, and whatever is reasonable and advan- 
tageous is being done to make the life of these unfortunates as bearable as 
possible. The enlightened policy of the State of Massachusetts is in marked 
contrast to the uncalled for and drastic action in several States where the 
establishment of leper settlements has been strongly opposed. 

A few years ago it was suggested that a number of lepers in the State of 
Washington be sent to a station near Fort Thompson, on Puget Sound, but 
it was argued that " Puget Sound it not, and will not become, a leper colony, 
and there is not a spot anywhere along its shores suitable for that purpose, 
and any attempt by the Government to develop a leper colony would be sure to 
arouse the bitterest resentment." The answer to this statement is that the 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 137 

essential facts of leprosy are generally misunderstood ; that the disease, while 
unquestionably contagious, is only very mildly so, and practically not at all 
when reasonable sanitary requirements are complied with. On the occasion 
referred to the argument was advanced that Seattle was one of the most health- 
ful cities in the world and the question was raised as to how the fact of a leper 
colony on Puget Sound would coincide with n campaign to advertise the health- 
fulness of the State. It was therefore argued that many a man " who would 
never know that the Sound was distinctly healthful, would know that it was 
the seat of a leper home — and the result would be to turn him against the 
entire section." In reply it may be said that the leper settlement at Penikese 
Island in Buzzards Bay has not in the least degree detracted from the 
enormous tourist and vacation traffic of that region during the summer months ; 
that as far as known the public is paying not. the slightest attention to the 
settlement, which is in precise conformity to the intelligence of the Massachu- 
setts people and their humanitarian regard for the most afflicted element of the 
population, and that there is not the slightest possible chance that the settle- 
ment could in any manner affect the health of the near-by region. The same 
conclusion applies to the settlement in Louisiana, and the one at Molokai. 

It is not true, as observed in the newspaper discussion referred to, that leper 
settlements " are invariably shunned by people." It is in fact quite difficult 
to keep away visitors from Molokai and the entire legislature visits the settle- 
ment once a year, without any apprehension whatever. The superintendent in 
charge of the settlement and the resident physician, as well as the Government 
experts, come and go without any let or hindrance and without the slightest 
apprehension regarding contagion on the part of anyone. Under proper sani- 
tary conditions the risk of contagion is extremely slight. Leaving out of con- 
sideration the case of Father Damien, there have been only two cases of 
infection of white attendants at Molokai; but, much to the contrary, some of 
the officials in charge, including the superintendent, the resident physician, the 
sister superior and the Catholic brother in charge of the home for helpless 
cases, have been at the settlement for many years, and in daily, almost hourly, 
contact with cases in all stages of the disease, but happily without disastrous 
results. 

The same conclusion applies to the settlement in Louisiana. The attending 
physicians are well known in New Orleans, and they are not considered in any 
manner and rightfully so as likely to be sources of infection. The sisters in 
charge visit the city from time to time without let or hindrance, and it would 
be absurd to consider them in any way a menace to the community. These 
facts and observations should be fully sufficient to convince any person of 
average intelligence that a leper settlement is not, and can not by its nature be, 
a. menace to the health of the community, but, much to the contrary, its ex- 
istence, granting necessity, reflects the highest humanitarianism and civilization 
of the community, broadminded enough, and charitable enough, to aid in its 
establishment and maintenance. 

The maintenance appropriations for the Louisiana Leper Home, for the two 
years ended March 31, 1914, amounted to $46,500, but the total disbursements 
during the same period for all purposes, including improvement appropriations 
and cash donations, amounted to more than $76,000 net, or about $38,000 per 
annum. The total number of cases treated during the two years was 119, and 
the per capita expense per annum was $475. During the first 10 years after 
the opening of the institution the average number of new cases admitted was 
7.7, which compared with an average of 14.3 cases during the eight years ending 
with 1913. It is properly observed in the last biennial report that the most 
important factor in the exceedingly difficult problem of isolation " is an institu- 
tion recognized by the medical profession and the public as a place to which 
lepers can be sent with the full confidence that they will receive the best care 
and be offered the greatest prospect of amelioration or cure." The same 
reasoning applies to the need of national institutions on a similar scale to 
provide adequate and humane treatment for the few lepers in sections in which 
the disease is less common than in Louisiana or Hawaii. 

To much the same effect are the words of the Surgeon General of the United 
States Public Health Service, Dr. Rupert Blue, in an address on " The public- 
health aspects of leprosy in the United States," read before the American 
Medical Association in 1913. Dr. Blue remarks that " Every case of leprosy 
should be promptly reported to the proper health authority, and, wherever 
necessary, the laws should be so amended and penalties provided for nonobserv- 
ance. All lepers should be segregated in such manner as to prevent the spread 



138 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

of the disease, but the necessary segregation should be enforced so as to 
promote the comfort and happiness of those so afflicted." Reasoning from this 
fundamental principle of national control, Dr. Blue suggests that " On account 
of the difficulty of providing these conditions in towns, counties, and States 
where single cases of leprosy occur, and because of consequent inadequate 
methods of control, I believe there should be established under the Public 
Health Service a national leper home for the care and treatment of such cases 
as may be turned over by State and local health authorities for the purpose." 
A bill was accordingly introduced into Congress (H. R. 1751) providing for 
the establishment of a national leprosarium. In his evidence before the Com- 
mittee on Interstate and Foreign Commerce (there being no public-health 
committee of the House of Representatives) Dr. Blue made the statement that 
at that time (Dec. 15, 1914) leprosy existed in 18 States of the Union, and 
that while in some States the disease was notifiable, in others it was not ; and 
that while for himself he was convinced of the necessity of segregation, he was 
sorry to say that some health officers did not believe in drastic methods of 
control. Dr. Blue presented the following resolution, adopted by the section 
on dermatology, of the American Medical Association, June 24, 1914 : 

[Resolutions favoring the passage of a Federal law for the care and control of leprosy In 
the United States, adopted by the section on dermatology of the American Medical Asso- 
ciation, Atlantic City, N. J., June 24, 1914.] 

To the honorable house of delegates of the American Medical Association: 

" The section on dermatology of the American Medical Association respect- 
fully submits the following resolutions, which have been unanimously adopted 
by the section on June 24, 1914 : 
" Whereas leprosy exists in many foci in this country, and has been statistically 

shown to be on the increase ; and 
" Whereas those afflicted with leprosy are being subjected to most inhuman 

treatment ; and 
" Whereas many lepers are traveling in interstate traffic because of the inhuman 
treatment to which they are subjected, thereby constantly exposing th<* 
general public to the contagion ; and 
" Whereas it is the duty of the Federal Government to control traffic between 

the States; and 
" Whereas at the present time the care of lepers in the United States is a great 
economic burden on the individual States and is, moreover, of necessity 
inadequate from a medical and sanitary standpoint: Therefore be it 

" Resolved, That the association recommends the passage by Congress of a 
law for the comprehensive care and control of leprosy by the Federal 
Government." 

This resolution is in conformity to the accepted principles of leprosy control 
adopted by the Second International Conference on Leprosy, held in Bergen, 
Norway, August 16-19, 1909. The resolutions adopted by the conference read 
in part : 

"A. (1) The Second International Scientific Conference on Leprosy confirms 
in every respect the resolutions adopted by the First International Conference 
of Berlin. 1897. Leprosy is a disease which is contagious from person to per- 
son, whatever may be the method by which this contagion is effected. Every 
country, in whatever latitude it is situated, is within the range of possible 
infection by leprosy, and may, therefore, usefully undertake measures to pro- 
tect itself. (2) In view of the success obtained in Germany. Iceland, Norway, 
and Sweden, it is desirable that other countries should isolate lepers. (3) It 
is desirable that the children of lepers should be separated from their parents 
as soon as possible, and that they should remain under observation. (4) An 
examination should be made from time to time of those having lived with lepers 
by a doctor having special knowledge. It is desirable that lepers should not 
engage in certain trades or occupations. All leper vagabonds and beggars 
should be strictly isolated." 

The fundamental principle of segregation underlies every effort at govern- 
mental administrative control of leprosy as a menace to the public health. But 
the principle of segregation goes much further in that it also recognizes the 
humanitarian considerations, which are practically absent in any other form 
of treatment oi method of control. It is a lamentable fact that in the United 
States, including some of our larger cities, there is still an attitude of more or 
Joss pronounced antipathy toward segregation under humane and otherwise 






TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 139 

reasonable conditions. There is, furthermore, a most serious indifference re- 
garding the possibilities of leprosy spread through lepers permitted to go at 
large or treated privately under conditions which preclude the possibility of an 
effective protection of the community. The available evidence is absolutely 
convincing and entirely conclusive that wherever complete segregation has 
been practiced the disease has gradually diminished. This certainly has been 
the case in Norway since 1856 and in Hawaii during the last 20 years. The 
argument frequently advanced that the number of cases in this* country is 
insufficient to warrant drastic measures is but further evidence of the public 
indifference to the true aspects of the leprosy problem. The disease is so 
loathsome, so tragic and so hopeless, that the menace of its needless spread to 
another single case from even the foci of one existing case is a risk which 
no civilized country can rightfully take. On the other hand the disease is so 
mildly contagious, and so difficult of transmission under proper hygienic con- 
ditions, that the inhuman treatment of exceptional lepers throughout the coun- 
try . is but evidence of our backward condition with regard to one of the most 
tragic disease problems of modern life. 

Effective segregation is an expensive matter and the burden upon a single 
State may assume prohibitive proportions. An excellent illustration is the 
Massachusetts leper settlement at Penikese Island, under the medical adminis- 
tration of Dr. Frank H. Parker. The institution is administered by the State 
board of charities, and the plant is valued at $109,465. The normal capacity 
of the settlement is 19, or a per unit cost of nearly $6,000. The settlement pro- 
vides hospital care and treatment exclusively for persons afflicted with leprosy. 
During the year 1913, 17 patients were under treatment, of an average age on 
admission of 38 years. Eleven were suffering from the disease in the tubercu- 
lar form, 2 in the anaesthetic, and 2 in the mixed form. The proportion of 
females was only 4, or 23.5 per cent, out of the total of 17. A preponderance of 
male lepers has been observed in all countries for which trustworthy data are 
available. It is extremely significant that all of the patients on Penikese Island, 
with one exception, were of foreign birth or parentage, the races referred to 
being as follows : Chinese, 4 ; Portuguese, 4 ; Russians, 3 ; and 1 each from 
Japan, British West Indies, and Lettland. The expenditures for the year 
amounted to $23,390, of which $9,329 was expended for salaries, wages, and 
labor, and the remainder on account of maintenance, etc. The ratio of the 
daily average number of persons employed, to the daily average number of in- 
mates, was 1 to 4.7. 

The provision which is made for the segregation of lepers in the State of 
Massachusetts closely approaches the attainable ideal. It is in conformity to 
the efficient and humane methods of segregation at Molokai and the Louisiana 
leper home. Several additional institutions are required for other sections 
of the country. Until a person afflicted with leprosy has the positive assurance 
of adequate professional and humane care in suitable institutions under State 
or Federal control, the number of lepers at large is not likely to perceptibly 
diminish. 

It would be extremely difficult, however, to determine with a reasonable 
approach to accuracy, the existing number of lepers throughout the continental 
United States. There are no reasons, however, why the fundamental principles 
of the leper law of Hawaii should not be incorporated at least in the regula- 
tions of all the more important State boards of health. Every leper is a serious 
menace to the community and his effective segregation is not only of great im- 
portance to the Nation, but of equal importance to the leper himself. The 
proper treatment of leprosy requires special facilities which can not be had 
even in well-equipped hospitals, to say nothing of the crude and often inhuman 
provisions made for isolated lepers in quarantine stations or pesthouses. There 
would, therefore, seem to be no alternative but to bring about the establish- 
ment of one or more national leprosariums under the direct administration and 
control of the Federal Public Health Service. The essential provisions of 
House bill 1751 are as follows : 

" Be it enacted by the Senate and House of Representatives of the United 
States of America in Congress assembled, That the Secretary of the Treasury 
be, and he is hereby, authorized and directed to establish a national leprosarium 
in the United States or any of its insular possessions, the location thereof to be 
decided upon after proper investigation by the Surgeon General of the United 
States Public Health Service, subject to the approval of the Secretary of the 
Treasury. The Secretary of the Treasury shall have power to acquire, by con- 
demnation or otherwise, a suitable site for the leprosarium and and shall erect 



140 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

thereon all necessary buildings and thoroughly equip the same for the proper 
care and treatment of lepers confined therein and for the investigation and 
study of the disease of leprosy. 

" Sec. 2. That the Surgeon General of the United States Public Health Serv- 
ice shall appoint all medical officers, assistants, surgeons, pharmacists, and 
other necessary employees, and shall promulgate and adopt, subject to the ap- 
proval of the Secretary of the Treasury, all necessary rules and regulations 
to carry this act into effect. 

" Sec. 3. That, under authority of this act, and State or Territory of the 
United States is authorized to transport all persons afflicted with leprosy found 
therein to the leprosarium, and the Surgeon General is directed to receive the 
same, such transportation charges to be paid by the United States." 

This bill, and others like it, have been before Congress for several years but 
final action has been deferred. It is sincerely to be hoped that final action will 
be taken by the next Congress, but additional provision should be made for 
the gradual acquisition by the Federal Government of existing State leper 
settlements, so that ultimately all lepers may be segregated in suitable lepro- 
sariums under complete Federal administration and control. 

If this plan should be ultimately carried through there would be an end to 
the existing intolerable situation. It would be utterly impossible to even 
briefly review the considerable number of lamentable cases of isolated lepers, 
which for the time attracted considerable attention but were soon forgotten, 
while the lepers themselves remained exposed to needless suffering and a 
menace to the community at large. Reference requires only to be made to the 
unwarranted action on the part of the New York City health authorities in 
releasing a number of lepers from a temporary settlement on North Brother 
Island, to mingle with the community without let or hindrance, upon the 
erroneous assumption that leprosy is not contagious or transmissible from 
person to person in northern latitudes. As a matter of fact, leprosy is endemic 
and has been endemic in Iceland for many years, and the Louisiana foci prob- 
ably had its origin in the maritime Provinces, to which it originally may have 
been brought from Iceland or Norway. The number of lepers in Iceland at the 
present time is approximately 100. Only about two or three years ago the 
(then) commissioner of health of the city of New York was quoted in an in- 
terview in the Evening World, to the effect that " leprosy can not be contracted 
in this climate." At the same time a distinguished specialist was quoted to the 
effect that " In this region the presence of the disease is not a menace to the 
community " ; and a physician attached to the Metropolitan Hospital on Black- 
wells Island, was quoted as having declared that " In this climate the fear of 
leprosy is unwarranted." As far as known, climate has absolutely nothing to 
do with leprosy, and the cases which have been observed in northern latitudes, 
including Minnesota, completely contradict the assumption that leprosy may 
not become endemic in this country, unless the known cases are immediately 
and permanently segregated under suitable conditions. 

The case referred to is but a lamentable as well as sinister illustration of 
many. The disease is frequently given superficial medical consideration, as 
best shown in the well-known Early case, which was declared by a specialist in 
skin diseases, and attached to a well-known New York hospital, not to be 
leprosy, in opposition to the unanimous judgment of a committee of the New 
York Society for Medical Jurisprudence. At the present time, or about two 
years later, Early is one of two lepers segregated under far from satisfactory 
conditions in the District of Columbia. The specialist was fundamentally 
wrong, and the community was exposed to a most fearful risk because of :t lack 
of serious consideration of a case in its early but cognizable state. In a matter 
of such enormous importance to the community it would seem that the public 
at large is entitled to the benefit of a doubt until every reasonable suspicion of 
leprosy in a suspected case has been removed. 

Dr. Hoffman. Before I introduced my resolution, subsequently 
adopted by the American Academy of Medicine, I wanted to be sure 
that I had the sentiment of the country behind me. I therefore sent 
out my letter of inquiry, and I subsequently interviewed Dr. Dowling, 
State health officer of Louisiana; Dr. McLaughlin, State health 
officer of Massachusetts; Dr. Pratt, president of the Territorial 
Board of Health of Hawaii, and others, to ascertain their views. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 141 

The Chairman. You have a copy of your letter before you, have 
you not? 

Dr. Hoffman. Yes, Senator. 

The Chairman. To avoid any doubt about it, will you be good 
enough to put the letter into the record ? 

Dr. Hoffman. You mean one of the letters to the several State 
health authorities? 

The Chairman. Yes, Doctor; just the form of the letter. 

Senator Works. You mean the letter that the doctor wrote and 
sent out to the several States asking for information regarding the 
extent of leprosy in this country and the methods of segregation and 
care? 

The Chairman. Yes; the letter the doctor wrote to these various 
health authorities asking, among other questions, whether they were 
in favor of a National leprosarium. 

(The matter referred to is here printed in full as follows:) 

June 16, 1915. 
Secretary State Board of Health. 

Dear Sir : I have agreed to read a paper on " Leprosy as a National Problem," 
before the American Academy of Medicine, at the meeting to be held in Saa 
Francisco during the week of June 20. Either in my address, or in a supple- 
ment thereto, since the time is rather short, I expect to present in brief outline 
the provisions at present made for the segregation and care of lepers in the 
principal States of this country. Will you be good enough to let me have, at 
your earliest convenience, a reply to the following questions, and return this let- 
ter in the inclosed stamped envelope? 

1. What are the statutory provisions of your State or city for the segregation 
and detention of lepers? 

2. Is leprosy a reportable disease in your State or city, either according to 
law or under the rules of your board? 

3. What is the number of known lepers in your city or State at the present 
time? 

4. What provision is made for lepers in your city or State, either according 
to law or under the regulations of your board? 

5. If you have lepers under your supervision and control, please state their 
number and the institutional or other provisions made for their maintenance 
and care. 

6. In your opinion, is segregation of all cases advisable? 

7. Are you in favor of a national leprosarium to provide for the adequate 
treatment and care of at least such lepers as are apprehended by the authorities 
while in interstate transit, and which are probably the only cases which at the 
present time can be properly taken care of by the Government? 

Should you find it convenient and possible to reply to any or all of the fore- 
going questions, you will please accept in advance my sincere thanks. 
I remain, 

Very truly, yours, 

Frederick L. Hoffman, Statistician. 

Dr. Hoffman. As said before, all of the replies to my letter of in- 
quiry except one were emphatically in favor of a national lepro- 
sarium. 

The Chairman. Have you any other points, Doctor, that you would 
like to bring to the attention of the committee ? 

Dr. Hoffman. I think not, Senator; but I desire to conclude with 
once more urging it upon your committee that you give favorable 
consideration to this important measure which concerns, it is true, 
but a relatively small number of people on the mainland of -the 
United States, but at the same time an element peculiarly deserving 
of national consideration. 

33993°— S. Rept. 306, 64-4 10 



142 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

I trust that I have made it clear that in most cases adequate State 
care for lepers is entirely out of the question in isolated cases, and 
that the best possible results regarding the treatment and possible 
arrest of the disease are obtainable only at a properly maintained 
leprosarium. Furthermore, I hope that I have presented .all the 
necessary statistical evidence in support of the conclusion that the 
only means of the gradual eradication of leprosy is through effective 
segregation, such as has now been for many years ..practiced in 
Hawaii, Norway, and in many other countries with excellent, results. 
I have also tried to make clear to 3^ou the obvious interstate character 
of many of the cases of leprosy in this country, and the? inequity of 
the placing of the financial burden for the care of such cases upon the 
few States making adequate and humane provision for the treatment 
of these unfortunates. In Hawaii during 1912, which may be con- 
sidered a normal year, the sum of $232,000 was spent, on account of 
728 lepers, or $318 per capita; in other words, Hawaii spent more 
than $1 per capita per annum on account of leprosy alone. The ex- 
penditures at the Louisiana settlement amount to about $10,000 a 
year. In isolated cases, on account of the irrational and ill-advised 
methods prevailing at the present time, the expenses of maintenance 
and care often attain to needlessly considerable proportions. The 
establishment of a Federal leprosarium in a suitable location would 
provide the most effective means for the gradual checking of the 
disease, and last, but not least, for the more humane and proper care 
of the most afflicted element of the human race. Mr. Chairman, I 
should like to supplement my testimony by a letter which I shall 
address to you. 

The Chairman. We will be glad to have you do so. We are cer- 
tainly very much obliged to you for your testimony. 

Senator Works. Yes ; it has been very interesting. 

(The letter referred to was subsequently submitted, and is here 
printed in full, as follows:) 

The Prudential Insurance Co. of America, 

Newark, N. J., February 17, 1916. 
Hon. Joseph E. Ransdell, 

Chairman Senate Committee on 

Public Health and National Quarantine, 

United States Senate, Washington, D. C. 

My Dear Senator Ransdell : In addition to ray evidence before your commit- 
tee, I desire to place on record my emphatic indorsement of the principle which 
underlies the Senate bill providing for a national leprosarium. 

As emphasized in my resolution presented to the Thirteenth Annual Confer- 
ence of State and Territorial Health Officers, I feel that the duty of the Gov- 
ernment in this matter is so obvious as not to require elaboration, in view of the 
facts disclosed by my own investigations and as illustrated by the individual 
cases brought to the attention of your committee. 

Since fairly adequate institutions are available in Massachusetts, Louisiana, 
and California, it would therefore seem that the proposed leprosarium should 
be located somewhere in the Central West. It would probably be advisable to 
appoint a special commission to locate a suitable site, with a due regard to 
such foci of infection as Chicago, where it is claimed many cases are at large. 

My personal investigations at Molokai, at San Francisco, and in Louisiana have 
profoundly impressed upon me the duty of a persistent effort in behalf of these 
most unfortunate and absolutely helpless victims of a peculiarly loathsome and 
practically hopeless disease. No words of mine can give adequate expression 
to my own sorrow for these people, but in the light of my personal knowledge I 
can not but feel intensely the additional sorrow and suffering needlessly forced 
upon the helpless individual who suddenly and by no fault of his own finds 
himself the victim of leprosy in a State where he may be the only one of his 



TREATMENT OF PERSONS AFFLICTED WITH. LEPROSY. 143 

kind. I believe that the Nation owes it to itself and to the cause of a broader 
civilization that it shall leave nothing undone to provide liberally and humanely 
for these unfortunates who, under present conditions, are often most inhumanely 
treated. 

I believe that the Nation should follow the remarkable example of broad- 
minded philanthropy and true humanitarianism illustrated by the adequate and 
intelligent care of lepers in Hawaii, in San Francisco, in Louisiana, and in 
Massachusetts. I desire to direct the attention of your committee to the fact 
that the Territory of Hawaii is under an annual burden of about $230,000, or 
a per capita expense of $1, on account of leprosy alone. Since the disease 
was introduced into Hawaii by Chinese immigrants during the early thirties or 
forties, it was there as with us an international problem in its inception, which 
was practically beyond the power of any Territory or State to effectively safe- 
guard against. The most drastic quarantine measures could not possibly suc- 
ceed in keeping out leprous immigrants in the very initial or noncognizable 
stage of the disease, when the leper himself would in all probability be entirely 
unaware of the impending calamity. The average duration of this disease is 
about eight years between the time of obvious lesions and death. How long 
there is a preceding period of development has not been determined, but cer- 
tainly a number of years almost invariably elapses between the original contact 
infection and the first definite lesions which permit of a precise and conclusive 
diagnosis. It is therefore hopeless to anticipate the possibility of safeguarding 
the Nation against the introduction of leprous persons in the very initial stages 
of the disease from the many foci of infection in countries to the south of us 
or in the Orient, or even in Europe, with which we have close commercial and 
other relations. 

I omitted to direct the attention of your committee to the fact that Gloucester 
fishermen frequently visit Iceland during the fishing season, and that Icelandic 
leper patients have on a number of occasions been admitted to the lazaretto at 
Tracadie, New Brunswick. Icelandic leper cases have also occurred in the Cen- 
tral Northwest and in Manitoba. Thus the more thoroughly the disease is-. 
studied the more complex becomes the problem of control through existing State 
agencies alone. 

In the course of time I am absolutely certain the Nation will realize its com- 
plete duty and take over all of the existing leper settlements and care adequately 
and at national expense for all of these unfortunates whose support can not 
rightfully be charged against any particular locality as a burden to be provided 
for out of local revenues alone. 

I believe that a public agitation of the question will do much to bring about 
a more enlightened public opinion, and will emphasize on the one hand the duty 
and on the other the humanity of adequate care but unconditional segregation. 
Recalling as I do with genuine sorrow the lamentable condition of the more- 
than 1,000 lepers whom I have personally seen, and many of them more than 
once, I can not but strongly urge it upon your committee that you report 
favorably on the bill providing for a national leprosarium, so that our national 
conscience in this matter may be freed from the charge of inhumanity and indif- 
ference, not only toward the leper himself, but toward those unfortunates who' 
are now exposed to the frightful risk of a fate which is but a living death. 

I shall be pleased to be of any further service to your committee in connection' 
with this matter, and I make use of this opportunity to express to yourself 
and to your committee my sincere appreciation of your courtesy and kindness 
at the hearing on February 15. 

I remain, ! 

Very truly, yours, j 

Frederick L. Hoffman. 

The Chairman. I would like to have Dr. Fowler take the stand 
now and tell us about the Early case. 

STATEMENT OF DR. WILLIAM C. FOWLER, CHIEF MEDICAL IN- 
SPECTOR, HEALTH DEPARTMENT, DISTRICT OF COLUMBIA. 

The Chairman. Doctor, will you tell the committee about the case 
of John Early? 

Dr. Fowler. John Early first arrived in the District of Columbia 
in August, 1908. He was found in the Salvation Army headquarters 



144 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

on Pennsylvania Avenue, just below the Capitol, near First Street. 
At the time of his arrival we had no provision here whatever for the 
care of a leper, and I removed him from the Salvation Army head- 
quarters to reservation No. 13, which is a public reservation on which 
are located some of the public buildings belonging to the District of 
Columbia. 

The first night he was kept in the ambulance, because I had no 
place to take him. A cot was arranged for him in the ambulance and 
he was cared for as well as possible under the circumstances. The 
next day a tent was purchased and erected on the reservation, where 
he was kept for some time, until we finally succeeded in obtaining the 
use of a brick building owned by the District of Columbia, on the 
same reservation. Early, according to his statements, had been a 
soldier in the United States Army and had seen service in Cuba and 
in the Philippines. He claims, and I think it is true, that he con- 
tracted his trouble in the Philippines. In the portion of the islands 
in which he was stationed we ascertained there had been a consider- 
able number of cases of leprosy. 

He stayed in Washington until July of the following year, when 
he went to New York with a Dr. Bulkley, who had offered to take 
him there and care for him in the Skin and Cancer Hospital in New 
York City. The laws of the District of Columbia make leprosy a 
reportable disease, and we are required under the law to isolate it. 
Early was isolated from the time he was first found in this District, 
and in order to keep him watchmen had to be employed, and we have 
had to continue the employment of these watchmen ever since. This 
is his third visit here. When he went to New York in 1909 it was 
with the understanding that he would not return to the District of 
Columbia. Notwithstanding that promise, however, he returned here 
in December of the same year and paid a visit to the matron at the 
smallpox hospital to let her know he had returned. I took Early in 
charge again during the afternoon of the same day and placed him 
in quarantine, under arrest, because the laws of the District make it 
unlawful for any person to come into the District while suffering 
from leprosy. He stayed here until the following December, when 
he was against taken to New York City, with the promise, again, 
that he would not return. We lost all track of Early until some time 
later on, when I read in the public press that he was in California. 

The Chairman. Presumably he was traveling in public convey- 
ances all the time? 

Dr. Fowler. Yes. When he went from Washington he went in a 
baggage car, which was chartered for his special use, and disinfected 
at the other end of the line. He finally found his way to Taooma. 
Wash., and was later taken over by the Public Health Service at the 
Diamond Point Quarantine Station, where he was employed, I under- 
stand, as a nurse. 

When he first came to Washington, D. C, he came here in an effort 
to have his pension increased and applied at the Pension Office, where 
he came in contact with a number of officials at that office, talked with 
employees, and mingled with other persons around the city. He also 
visited public dining rooms here. After being in the State of 
Washington for some months — I have forgotten just how long ;i 
time — I received a telephone message one morning asking if I wanted 
John Early, There was some little conversation over the phone, and 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 145 

I was told that if I would go to a certain hotel, w T hich is one of the 
most prominent in the District of Columbia, I would find John Early- 
registered under a certain name. I did not know whether it was 
some one joking with me or not, but I went, however, to the hotel 
n^med, and on entering the room found John Early in consultation 
with several newspaper reporters of this city. I again took him in 
charge. That was, I think, on the 2d of June last, but I have for- 
gotten the exact time, and I have had him here since. 

Senator Works. What is his age now, about ? 

Dr. Fowler. I should judge he is about 47 or 48. 

Senator Works. Has he any family? 

Dr. Fowler. He had a wife and three children. 

Senator Works. Do you know what became of his family? 

Dr. Fowler. Yes. When he came here first he had one child — a 
wife and child. While here on his first visit another child was born 
in the brick building of which I spoke. After he left Washington 
there was another child born somewhere in the West— I think, in 
California or in the State of Washington; I do not recall which. 
While in the State of Washington his wife applied for and secured a 
divorce, so he is to-day a divorced man. He is a United States pen- 
sioner ; he gets a pension of $30 a month. He has been a considerable 
expense to the District of Columbia, because he is the only one we 
have here at this time. 

The Chairman. About how much expense a year, Doctor ? 

Dr. Fowler. We recently looked up the matter for the year 1915, 
and his expenses for that year were approximately $3,200 or $3,300. 

The Chairman. Has there been any occurrence of the disease in his 
family — his wife or children ? 

Dr. Fowler. So far as I know, there has not been. I do not know 
just where they are. 

We had here a short time ago this man Grable who was referred to. 
He has wandered all over the country, according to his own state- 
ments. He was quarantined, he tells me, in Salt Lake City, San 
Francisco, New Orleans, St. Louis, and also here in Washington. He 
escaped one night some months ago from our place and went to Pitts- 
burgh. He was then taken over by the Public Health Service, and I 
think, succeeded in eluding them and wandered back to Pittsburgh, 
and I recently read a letter from him to John Early, in which he 
stated that when he got back to Pittsburgh the people there felt so 
badly about his return, and he felt so sorry for them, he left and went 
to St. Louis, and that is where he is now— at Koch, near St. Louis, 
Mo. He seems to be able to wander around as he pleases, as has been 
the case with Early. 

Senator Works. How do they get money with which to travel 
around ? 

Dr. Fowler. Grable is an old railroad man, and I imagine he has 
some secret signs by which they help him along. As John Early was 
receiving money from the Public Health Service while in their 
employ, and $30 a month pension, I imagine he accumulated quite a 
little money. He told me he traveled in the best style in coming back 
from the State of Washington. He traveled all the way across 
Canada in a Pullman car, and when he arrived in Washington, D. C, 
stopped at one of the best hotels in this city. 



146 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. He was there registered as a guest, and occupying 
a room in that hotel? 

Dr. Fowler. Yes ; that is where I found him the last time. 

Senator Works. What is the extent of the disease in his case? 

Dr. Fowler. He has quite a number of anaesthetic areas and quite 
a few nodules and some swelling of the limbs, but he is very much 
better now than he was some time ago. He seems to be very anxious 
for this national home, and he has spoken to me about it on several 
occasions. He alleges that is why he came back to this city, so as 
to agitate this question; and he stated to Senator Ransdell on Sun- 
day that he was exceedingly anxious for this home, and would go 
there, and that he thought all the other lepers in this country would 
do the same. 

Senator Works. Do you think it would be a good thing to have 
him come here and testify? 

Dr. Fowler. I would be glad to have him come here if the com- 
mittee so desires. 

The Chairman. What means have you taken to have him con- 
fined? 

Dr. Fowler. We have him in this brick building at the present 
time; the windows are barred, and the door is barred. 

The Chairman. Barred with steel? 

Dr. Fowler. Yes. John Early, at the present time, is under 
arrest- under the laws of the District of Columbia, for coming into 
said District while suffering from leprosy and without a permit so 
to do. 

The Chairman. He is under arrest because he came here, being a 
leper ? 

Dr. Fowler. Yes; and knowing it. The grounds surrounding the 
home are inclosed with a barbed-wire fence. 

The Chairman. About how high? 

Dr. Fowler. About 8 feet in height. 

The Chairman. With a projection over at the top? 

Dr. Fowler. Yes; sort of a T-shape top. 

The Chairman. So it would be almost impossible for him to get 
out? 

Dr. Fowler. It would be quite difficult, I should say. On the first 
of this month we changed the plan of caring for him by employing 
a man and his daughter to stay there all the time, and we have done 
away with the expense of watchmen, and the expense it is believed 
will not be as great as it has been heretofore; but I want to say that 
it has not been more than a month — this is not known generally, 
however — that he did make a desperate attempt to escape; and he 
came near getting away. 

Senator Works. You are now treating him practically as a wild 
animal? 

Dr. Fowler. Practically, I am afraid ; we have to in order to keep 
him. 

The Chairman. You have a comfortable room for him there? 

Dr. Fowler. Yes ; as comfortable as we can make it. 

Senator Works. I did not mean to reflect upon your treatment of 
him, Doctor. 

The Chairman. Oh, no; I agree with you. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 147 

Dr. Fowler. I think a national home would be an exceedingly 
beneficial thing. It would be a great protection to the public and 
a more humane way of caring for these unfortunate people. 

The Chairman. His condition there was as sad as could be. He 
used the expression that his condition was as bad almost as being in 
hell. You remember, Doctor, he used that expression? 

Dr. Fowler. Yes. 

Senator Works. Do you know anything about the degree of suffer- 
ing that results from the disease? 

Dr. Fowler. I have only had three cases here. All of them were 
contracted in the Philippine Islands. One was a Filipino, brought 
here by a naval officer, and he was deported; the other case was 
Grable. John Early has at times suffered considerably from neu- 
ralgic pains, and it has been necessary to administer drugs to relieve 
him, but, generally speaking, he suffers very little. There have been 
times, however, when he has suffered considerably. 

The Chairman. He had a fairly healthy look about his face. 

Dr. Fowler. He is looking very much better now than he was a 
month ago. 

The Chairman. Doctor, would you be willing to take Senator 
Works, or any other members of the committee who desire to see 
Early, down to see him some day ? 

Dr. Fowler. I will be glad to do so any time. 

Senator Works. I think I would be perfectly willing to take the 
Doctor's statement about it. I would not have any fear, Doctor, 
but those things are not pleasant to look upon. Where it is neces- 
sary, I am perfectly willing to do anything of that sort, if anything 
may be gained by it, however. 

Dr. Fowler. I would like very much to take the committee down 
and show them the home and the surroundings, which are the best 
we can do for him. 

Senator Works. I would be glad to see it. 

The Chairman. They seemed to be the best you could do under 
the circumstances, but it is a sad thing. Thank you very much, 
Doctor, for your testimony. 

We will now hear Mrs. Crafts. 

STATEMENT OF MRS. WILBUR F. CRAFTS, OF WASHINGTON, D. C. 

Mrs. Crafts. If I might, I would just like to revert to the subject 
that was under discussion a few moments ago. 

The Chairman. Treat it in your own way, Madam. 

Mrs. Crafts. About whether or not the lepers should have permis- 
sion to go or not to go to the leprosarium, if it be established. I 
want to say that a very few years ago I was in Jerusalem, the Holy 
City, and I was told that there is a leper home there for those who 
wish to go there, but they are not obliged to stay in the home. I 
took an early morning walk down the Mount of Olives, into the 
Garden of Gethsemane, and then around the city of Jerusalem, and 
on my way I saw a mile of lepers — about between 200 and 300 
lepers — on both sides of the common road down the hill and into 
Jerusalem — the most miserable looking people that I ever saw in my 
life, and the most terrible cries coming from their throats that T 



148 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

ever heard. I saw little babies crawling in the dust of the road; 
they were not lepers, but they had leper parents there. I never saw 
human beings in such a terrible condition as those lepers ; and, worst 
of all, I saw a Turkish officer come and collect taxes from those lepers 
on gifts that travelers had given them as they sat there. They did 
not choose to live in the home that had been provided for them ; they 
were not forced to live there ; and they preferred to sit out on the 
roadside and beg. 

The Chairman. And they live by begging? 

Mrs. Crafts. Yes ; they live by begging. So, it would seem to me, 
if we have a leprosarium, the lepers ought to be obliged to live in it. 

The Chairman. That they should be compelled, by law, to go 
there ? 

Mrs. Crafts. Yes; it would make it safer for other people. 

The Chairman. And better for them ? 

Mrs. Crafts. Yes ; and better for them. 

I went to Iceland about five years ago to study sociological condi- 
tions. There is a leper hospital in Iceland which is much finer than 
the Parliament House. It is an up-to-date hospital, and in it are 
gathered 100 lepers, all of the lepers in Iceland. 

An invitation was sent to me by some lepers in the leper hospital to 
come and visit them, and so I walked over to the leper hospital. I ex- 
pressed my surprise at there being leprosy in Iceland, and I was told 
that it was largely on account of their diet. There are no vegetables 
grown in Iceland, only just a very few potatoes, and their diet is 
mostly fish, and, while in season fish are very delicious in Iceland, 
when they are preserved they are not very nice, and they eat them 
all — heads and tails and everything else about the fish — and they are 
carried on little ponies, and emit a very foul odor as they pass along 
the roadway ; and I was told that the leprosy was very largely on ac- 
count of the decayed fish which the people eat. At the leprosarium I 
talked with the lepers for about half an hour, and had a most interest- 
ing conversation with them, all in Esperanto. I could not speak a 
word of Norsk, nor could they speak a word of English. They told 
me " Esperanto gives us a very pleasant occupation here in the 
hospital, and it makes us feel that we still have a hold on the world." 

They could talk to anybody from any part of the world who could 
speak Esperanto. 

The Chairman. Do many of the lepers speak Esperanto? 

Mrs. Crafts. About eight talked with me. Those were all who 
came out for the interview. This interview was afterwards published 
in the Esperanto magazines throughout the world, and there was one 
gentleman, a physician in London, who said " If he were not already 
an Esperantist that incident alone would make him one." 

The Chairman. Did these lepers seem to be well cared fori 

Mrs. Crafts. Beautifully cared for. As I said, their building was 
more handsome than the Parliament House, and I may say the funds 
for it were all furnished by the Good Templars of Iceland, and it is 
sustained and carried on by the Good Templars in connection with 
the national government, so in one sense it is a national leprosarium; 
and the great contrast between those lepers and the lepers I saw in 
Jerusalem makes me feel that when there is a leprosarium all of the 
lepers should be obliged to live in it. 



TREATMENT OF PERSONS AEFLICTED WITH LEPROSY. 149 

The Chairman. How have you felt toward a measure of this kind, 
Mrs. Crafts? 

Mrs. Crafts. I am very much in favor of it, and I hope that the 
measure will prevail, and that we shall have a National leprosa- 
rium in the United States. 

The Chairman. We are very much obliged to you, Mrs. Crafts. 

We will take a recess now until 2.30 to-morrow, at the Commerce 
Committee room of the Senate, in the Capitol. 

(Whereupon, at 5.15 o'clock p. m., the committee adjourned until 
to-morrow at 2.30 o'clock p. m., Wednesday, February 16, 1916, to 
meet in the room of the Committee on Commerce in the Capitol 
Building.) 



CARE AND TREATMENT OF PERSONS AFFLICTED WITH 
LEPROSY. 



WEDNESDAY, FEBRUARY 16, 1916. 

United States Senate, 
Committee on Public Health and 

National Quarantine^ 

Washington, D. 0, 
The committee met in the room of the Committee on Commerce, 
Capitol Building, at 2.30 o'clock p. m., pursuant to adjournment, 
Senator Joseph E. Ransdell presiding. 
Present: Senators Ransdell (chairman), Fletcher, and Works. 
The committee resumed the consideration of the bill (S. 4086) to 
provide for the care and treatment of persons afflicted with leprosy 
and to prevent the spread of leprosy in the United States. 

The Chairman. Dr. Woodward, we will hear from you first. Tell 
us what you think of the bill we have here under consideration. 
Dr. Woodward. Very well. 

STATEMENT OF DR. W. C. WOODWARD, HEALTH OFFICER OF THE 
DISTRICT OF COLUMBIA. 

The Chairman. If you have any facts in regard to this proposed 
legislation, I would be glad to have you state them to the committee. 
I will say, before you begin, that, in regard to Mr. Early, who is 
immediately under your charge, your subordinate, Dr. Fowler, gave 
us pretty full information as to the facts in his case. 

Dr. Woodward. We have had in the District of Columbia, as you 
may know, two other cases. 

The Chairman. He spoke of Grable. 

Dr. Woodward. Grable is one. He, like Early, contracted the 
disease in the Philippines, according to his history. The other 
patient was a Filipino, who was brought here in the family of a 
naval officer. 

The leprosy problem of the District of Columbia has been essen- 
tially of Federal origin, inasmuch as all the patients came from the 
Philippines in connection with Federal^ services. They might rightly 
feel, therefore, that they have a special claim for Federal protec- 
tion. 

Senator Works. Besides, these cases are here in the District of 
Columbia, where the National Government has exclusive jurisdiction. 
That would make a difference also. 

Dr. Woodward. Certainly. My contact with these lepers • and 
the occasions that I have had to look into the subject of the establish- 
ment of a Federal leprosarium have shown me some of the possible 
difficulties in the way of operating such an institution, which ought 

151 



152 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

to be cleared up, it seems to me, or at least fully anticipated and 
provided against, before the project is embarked upon. We seem 
to be proceeding here upon the presumption that all the lepers in 
the United States, or many of them, will be desirous of going into a 
Federal institution. I am not so sure that that is the case. We 
found, for instance, that our Filipino patient and Mr. Early were 
rather choice as to where they would go and where they would not 
go; and I am sure that the same question will arise with respect to 
anyone who develops leprosy in any part of the United States when 
it is proposed to carry him to some more or less remote point, where 
his family can not see him and where he can not see his family. 

Senator Works. That is a matter that was remarked upon the 
first day of the hearing. I think it was one of the witnesses from 
your State, Mr. Chairman. 

The Chairman. Yes, Dr. Dyer. 

Senator Works. The question arose as to whether they would con- 
sent to go long distances away from their homes in order to enter a 
national leprosarium. 

Dr. Woodward. The sanatorium in Louisiana is not a very long 
distance away from the homes of the lepers in that State, of course. 
It is so near New Orleans that you can leave New Orleans for the 
sanatorium in the morning and be back home that evening ; but if the 
proposition be to transport a man half way across the continent, or 
all the way across the continent, the situation will assume a very dif- 
ferent aspect. 

The Chairman. That home is only about 30 miles from the State 
capital. As you say, it is easily reached from New Orleans, as it is 
so close to that city that one may leave New Orleans and go to the 
colony and return back home the same evening. 

Dr. Woodward. The patient does not abandon his family, and his 
family does not abandon him, when he goes to that institution, such 
a short distance away. I think that is a very important factor. 

I have not been able to satisfy myself that it will be possible to 
take a leper from a given jurisdiction and, either under Federal law 
or under State law, convey him from his home to some remote point 
outside of that jurisdiction. 

The Chairman. There is no question about the right to take him to 
a home which is within the jurisdiction of the State, is there, Doctor? 

Dr. Woodward. That I would prefer not to express an opinion 
upon, without further inquiry. If it can be shown that the removal 
is reasonably necessary in order to protect the public health, beyond 
question he can be taken away; but if within the limits of his own 
home isolation be practicable, I think we may find that he is entitled 
to stay in his own home. The Government can, of course, impose 
on any citizen any needful regulation for the protection of the public 
health ; and if a man violates that regulation, the Government can. 
of course, punish him. 

The Chairman. If he were a man of sufficient means to carry out 
in his own home the regulations which the public health authorities 
thought to be sufficient to fully protect the public, you would ques- 
tion the right to forcibly remove him from his home? 

Dr. Woodward. Very much. 

The Chairman. But if he happened to be a poor man who did not 
have the means to take those precautions, and the public would per- 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 153 

haps thereby be in danger, then they would have the right to take 
him away ? 

Dr. Woodward. In its own defense; yes. It could not be done 
simply by reason of his poverty. 

Senator Works. You could not make any distinctions between 
classes and individuals, could you? 

Dr. Woodward. No. You would have to place it upon the inability 
of the poorer man to comply with the regulations. If the poorer man 
was able to comply with the regulations, as well as the man of better 
circumstances, they would both be on the same footing. 

Senator Works. The courts have gone a long ways in upholding 
the police regulations for the protection of the public health, even 
to the extent of destroying property in many cases; and I am in- 
clined to believe that the Government would have the power to go to 
the extent of compelling a person of that kind, if his presence en- 
dangers the public health, to go somewhere where the public would 
be protected from the menace. 

Dr. Woodward. I agree with you entirely; but whether a leper 
living under reasonable conditions constitutes such a menace to 
public health is quite a different problem. A statute providing for 
such removals might, of course, be regarded as such a legislative 
determination of the necessity for such action as the courts would 
not review. 

Senator Works. That is a question of fact which might come in, 
of course. 

Dr. Woodward. I do not believe we could show the unconditional 
necessity for the segregation of every leper, no matter how he may 
be situated. 

Senator Works. That might be. 

Senator Fletcher. You do not believe that it is sufficiently es- 
tablished that the disease is so contagious that it might be communi- 
cated or is infectious? 

Dr. Woodward. It is not readily communicable. It is not so com- 
municable as ordinary pulmonary tuberculosis. So if we should 
reason that we may take a leper, regardless of his circumstances, and 
transport him to some public institution, we may reason equally well 
that the same course will be sanctioned in the case of a person suffer- 
ing from tuberculosis. 

Senator Fletcher. That might be so. 

Dr. Woodward. In order to get definite knowledge of the pros- 
pect of filling the proposed leprosarium inquiry might be directed 
to persons most directly affected — that is, the known lepers in the 
country. How many of those who are now registered as leper 
patients would go to a Federal leprosarium and under what condi- 
tions ? That question might be answered by such a procedure. 

The Chairman. How would you consider this practicable when 
the health authorities have testified that they could not find more 
than about 146 in the whole of the United States, although they are 
satisfied that there are a great many more, and some go to the ex- 
tent of saying that there are from 800 to 1,200, and others that there 
are three times that many in the United States? 

Dr. Woodward. A poll of those registered lepers would afford an 
index probably to the entire leper population. 



154 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. Most of those that you know about are in leper 
homes, in Louisiana, in San Francisco, or rather in California, and in 
Massachusetts. They are probably pretty well provided -for. They 
are already in good homes. 

Dr. Woodward. Yes. : ".- 

The Chairman. You think that < what they would say about it 
would be an index as to the lepers generally? Take those in Louisi- 
ana^ for instance. They probably would not want to leave there 
and go to a national home. 

Dr. Woodward. What they would say would afford, I think, an 
index, so far as that class is concerned — that is, persons who are 
accommodated in that way. On the other hand, we have, notably in 
Minnesota, a reasonable number of lepers who are not accommodated 
in that way, and are scattered here and there throughout the coun- 
try. It is the occasional leper, who is not taken care of by an in- 
stitution, who needs a leprosarium, such as is contemplated by this 
bill. There is one here in Washington; there is one in Richmond, 
Va. ; there are some in Missouri. They are scattered throughout the 
United States. There are some in Texas and some in California. 
The California institution is in San Francisco and is a San Fran- 
cisco institution and not a State institution. Elsewhere in the State 
lepers are in the county poorhouses. 

We would get by this sort of inquiry an index to what might be 
expected of all of those lepers. If we can not find 600 or more lepers 
under the present circumstances, the question arises whether we 
would be any better able to discover them if we had an institution for 
their care. I do not think we would. 

The Chairman. You did not hear the testimony of Dr. Engman 
yesterday, did you ? 

Dr. Woodward. Yes, sir; I did. 

The Chairman. You don't agree with him that the doctors would 
be more willing to give the facts of a case if there was a comfortable 
place to put them ? He said that the doctors would make it known 
when there were leper cases if there was such an institution to put 
them in. He said after his harrowing experience in connection with 
a man he mentioned — I forget his name 

Dr. Woodward (interposing). Mr. Hartmann. 

The Chairman. Yes ; he said that after that experience the doctors 
there would not report another case of a leper if one was discovered. 
They would not subject them to the barbarous treatment of the one 
he told about. 

Dr. Woodward. I think the result might be the same even if 
there were a Federal leprosarium. Realizing that to report a case 
meant not this isolation by public sentiment, but transportation to 
some place remote, it might be, from family and friends, the physi- 
cian would be even less willing to make report. I am not sure about 
that. That is speculation, of course. 

The Chairman. I am not sure either. 

Dr. Woodward. There is another complicating element — the atti- 
tude of such States as New York, where a leper is at liberty to go 
and come absolutely at will. Lepers have there their own haven of 
refuge as long as they will go there. 

The Chairman. By haven of refuge you mean the entire Common- 
wealth of New York? 



TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 155 

Dr. Woodward. The entire Commonwealth of New York; yes, sir. 

The Chairman. You do not mean a home for them? 

Dr. Woodward. No. 

Senator Fletcher. They do not restrain them at all ? 

Dr. Woodward. Not in the least. 

Senator Fletcher. Is not that rather dangerous ? Is not the leper 
a real menace? 

Dr. Woodward. That is the opinion, I believe, of the vast ma- 
jority of physicians. New York State has been influenced, however,, 
by the opinions of men there who are men of standing and ability 
and whose influence has led to the present attitude; and so long 
as that opinion prevails in one State or in two or more States, of 
course no State is protected. Take, for example, our patient Early. 
When we first had John Early, he went to New York State with the 
consent of the New York State authorities and the United States 
Public Health Service. He stayed there as long as he felt willing 
and then departed for parts unknown, turning up in the State of 
Washington. 

Senator Works. I do not understand how any such mutual consent 
as that can be given, especially by the Public Health Service. 

Dr. Woodward. Their consent is merely to transport across State 
lines. 

Senator Works. That is consent that he might be turned loose on 
the community, is it not, Doctor ? 

Dr. Woodward. Theoretically it was not, because having gotten 
into the State of New York it was then against the interstate quaran- 
tine regulations for him to cross the State line to another jurisdiction. 

Senator Works. The result of that was to turn him loose in a State 
where he was at perfect liberty to go where he pleased, was it not ? 

Dr. Woodward. I see the point, Senator. The State was willing 
to receive him and his friends were willing for him to go. 

Senator Works. That would hardly justify you in turning him 
loose. 

Dr. Woodward. That was merely turning him over to New York. 
Our permit was merely for him to cross State lines. 

Senator Fletcher. How about the case of the Filipino ? 

Dr. Woodward. Early was first allowed to go to New York State, 
with the consent of New York State authorities and the Public 
Health Service, and he was to remain there. He later turned up in 
Washington again, but was arrested, and again, on account of our 
inability to get him before the courts, he was allowed to return to 
New York State, where he remained for a while. He later left there 
and then traveled over the country, finally turning up in the State 
of Washington. He subsequently left there, traveled over the coun- 
try again, and turned up here in one of our fashionable hotels, tele- 
phoning us that he was there. I suppose he did that because his 
money had run out and he did not have any place to go. He is now 
with us. 

Senator Fletcher. Who is taking care of him? 

Dr. Woodward. The District of Columbia. 

Senator Fletcher. At its own expense? 

Dr. Woodward. Yes. 

The Chairman. It costs $3,200 a year, as one of the physicians 
under Dr. Woodward testified. 



156 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Dr. Woodward. The patient Grable escaped from us and is now 
in St. Louis, Mo. The Filipino we finally got back to the Philip- 
pine Islands. We arranged, through the courtesy of the Bureau of 
Insular Affairs of the War Department, to have him returned to the 
Philippines, on condition that we delivered him on board the trans- 
port at Seattle. It was a supply transport, and we were to build a 
cabin on the boat, which he might occupy on his journey across the 
Pacific, and which was then, on his arrival, to be destroyed. 

The Chairman. Do you remember what it cost to get him over ? 

Dr. Woodward. We chartered a baggage car and put into it all 
necessary articles to take care of him, food, etc., and means for taking 
care of his excreta. We sent him, with one of our men from the 
health department, across the continent to Seattle, and delivered him 
on board the transport. 

Senator Fletcher. Don't they claim to have discovered a remedy 
for leprosy in the Philippines? 

Dr. Woodward. They claim to have discovered a new and more 
effective application of an old remedy ; that is, chaulmoogra oil. The 
most conspicuous difference in the present treatment is that the oil 
is hypodermically used. We tried it with Grable, but he said the 
treatment was too painful; that if we could give him any assurance 
of a cure he would be willing to submit to the treatment; but he 
objected to submitting to this painful treatment if it was going only 
to prolong the days of his disability and disfigurement. He declined 
to take the remedy. 

The Chairman. Dr. Dyer spoke of 30 cases which he considered 
had been cured, and some others spoke of cases that had been very 
considerably mitigated, not cured, and which they did not know 
whether could be cured or not. 

Senator Works. Is that man Grable getting better? 

Dr. Woodward. He is on the down grade now. In the early days, 
his symptoms would disappear and he would feel that he was getting 
well, and those unfamiliar with the disease apparently felt that he 
was well, but he then had a relapse. Now, he is in pretty bad shape. 

Senator Works. Would his physical appearance indicate that ? 

Dr. Woodward. Oh, clearly. The gross features generally, en- 
larged hands and feet, all indicate that. 

Senator Works. There is no longer any doubt about his having it ? 

Dr. Woodward. We never did have any doubt. 

Senator Works. I suggest, in view of what the doctor says, that 
it might be well to ask the Department of Justice to give us an opin- 
ion as to the power of the Government to compel the transportation 
of these people and their confinement in a sanatorium. 

The Chairman. I think it would be advisable to have that ; yes. 

Senator Works. If I had time to do anything toward it myself, I 
would be glad to get it up. 

The Chairman. Do you think we ought to have it in this hearing? 

Senator Works. I think we ought to have it; yes. 

The Chairman. Don't you think it would be time enough if we 
had it when we take up the bill and consider it? This is only the 
hearing of the bill, and I would like to have it concluded to-day, if 
possible. 

Senator Works. Oh, I do not mean to stop the hearing to get it. 
but I think we ought to have it. 



TEEATMENT OP PEESONS AFFLICTED WITH LEPEOSY. 157 

The Chairman. I think it is a good idea. 

Senator Works. We have this situation, that a large proportion 
of the known lepers are provided for now. The people in your State 
are amply provided for? 

The Chairman. Very adequately; yes. 

Senator Works. They probably could not have any better treat- 
ment under the Government? 

The Chairman. I do not think they could. 

Senator Works. So it has been testified that the people in Cali- 
fornia are receiving good treatment, and those in Massachusetts also. 
There are really most of the known lepers in those States. They 
would have very few more known lepers. 

The Chairman. Dr. Dyer testified very positively that there were 
others. 

Senator Works. Take the case in Louisiana. If I remember 
rightly, the doctor said that there were quite a number that were 
not willing to go to the home. There is a place where you could test 
the question. 

The Chairman. If they are not willing, the courts send them. Dr. 
Dyer said it was a case of putting them on trial just as in lunacy. 

Senator Fletcher. And the judiciary determines whether they 
shall go or not ? 

Senator Works. I don't remember of his saying that. 

The Chairman. He said that 20 per cent of the cases in Louisiana 
were sent to the home by compulsion of the court. 

Senator Works. I understood that 20 per cent were not willing 
to go. 

The Chairman. I think I asked him specifically about that, and 
he said that 80 per cent were willing to go, and that 20 per cent were 
sent there by compulsion. 

Senator Fletcher. How does Missouri deal with the question ? 

Dr. Woodward. I don't know. 

The Chairman. Dr. Engman testified rather fully on that yes- 
terday. 

Dr. Woodward. They have some sort of an establishment outside 
of St. Louis to which these cases are sent. Dr. Engman referred to 
that in connection with the man Hartmann, and referred to the fact 
that they had a Chinaman there. They also at one time had our 
friend Grable there. 

The Chairman. It was attached to a pesthouse, as I remember the 
testimony. 

Dr. Woodward. The same is true of Pittsburgh, where Grable went 
when he left Washington. They were in distress because they had 
had a leper there, but he had died shortly before Grable arrived, and 
they had destroyed the building. When Grable arrived there they 
were without a place to put him. 

I would like the record very clearly to show that I am in hearty 
and thorough sympathy with the establishment of a leprosarium if 
we can make it accomplish its purpose ; but I would not want to see 
a fiasco made of the movement by getting an institution and then not 
being able to accomplish the purposes for which it was established. 
I think a thorough inquiry should be made along these lines which I 
have suggested before any appropriation is made or anything done. 
33993°— S. Kept. 306, 64-1 11 



158 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

I think any appropriation should be safeguarded so that the pro- 
posed purposes may be accomplished. 

The Chairman. I think that is very wise. 

Senator Works. I think you are quite right about that, Doctor. 

Senator Fletcher. This man Early has a family, hasn't he? 

Dr. Woodward. Yes ; he has had. 

Senator Works. That was explained before, that he had a wife, 
and had had one child before he was afflicted, and then had two 
afterwards. 

The Chairman. Doctor, I am requested by Mr. Trundle, a resident 
of this city, to ask you these questions. 

Dr. Woodward. Very well. 

The Chairman. The first question is, Is it not a fact that provision 
would have to be made in this bill or elsewhere to transport affected 
persons from one State to another, even though the person under 
consideration was himself willing to be so transferred? I think you 
have already covered that. 

Dr. Woodward. I think so, yes. The only provision that I can 
conceive of is money to pay his expense of transportation. 

The Chairman. Yes. 

Senator Works. It might be necessary, Doctor, to protect others 
traveling from contamination. There perhaps ought to be a sepa- 
rate car, as in the case of the man you transported to Seattle, in send- 
ing him to the Philippines. 

Dr. Woodward. It is only a question of money to provide attend- 
ants and conveyance. 

Senator Works. Yes; it is only a question of money, I should 
think. 

The Chairman. The next question is, Does not Mr. Early claim 
that his present condition of health is due largely to confinement in 
an unhealthy locality? 

Dr. Woodward. Not so far as it relates to leprosy. Mr. Early has 
been acutely ill with what was probably a malarial infection, al- 
though we are not prepared to say that. He might have claimed that 
something of that sort was due to his confinement in the house where 
he now is. 

The Chairman. No. 3 is, Is not Mr. Early being held now in 
violation of the Constitution, not because he is held as a leper, but 
because there are charges here pending against him and he has no 
opportunity of having these charges decided? 

Dr. Woodward. I should say that Mr. Early is being held now in 
two ways. One is by virtue of a warrant for his arrest, issued by 
the police court, for violating the laws relating to leprosy in the 
District of Columbia, inasmuch as, knowing that he was a leper, he 
deliberately came back here and moved from place to place and ex- 
posed others; for that a warrant was procured against him. The 
case has not been brought to trial, and perhaps, the police court is 
not particularly anxious to take up the case. 

Senator Works. Probably not. 

Dr. Woodward. He has been notified that so far as the health de- 
partment was concerned he could get a trial, and we have written 
to the corporation counsel with respect to the matter; but the cor- 
poration counsel has not proceeded. Aside from that, as a leper, 
in the District of Columbia he is subject to exactly the same restric- 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 159 

tions as he would be if he were suffering from smallpox. The same 
law is applicable alike to anyone who suffers from either disease. 

Senator Works. If he was tried under the other charge, he would 
not be released from it ? 

Dr. Woodward. He might be locked up in his present quarters and 
be fined as much as $200, but that is all. 

Senator Works. He would still be subject to confinement? 

Dr. Woodward. He would still be subject to confinement because 
he is a leper, and the law specifically authorizes the court to desig- 
nate any safe place in which to confine a person suffering from 
leprosy. 

Senator Works. Do you think there is any ground for the claim, 
if it be a claim, that he is being kept in insanitary conditions? 

Dr. Woodward. I think not; further than it relates to the prox- 
imity of the place where he is confined to the swamp area, which is 
perhaps not an ideal place, because it is on the borders of the 
Anacostia River. The same thing applied for years to the District 
workhouse and poorhouse, and it applies now as to the jail, the 
Washington Asylum Hospital, the smallpox hospital, and the quar- 
antine station. 

Senator Works. I do not think that comparison would be very 
creditable to the place where he is confined. 

Dr. Woodward. No ; but the Government is proceeding as rapidly 
as possible to abate the nuisance. 

The Chairman. I have a letter from John Early, directed to me, 
dated Washington, February 14, 1916. It purports to come from 
John Early. Do you know that it came from John Early, Doctor? 

Dr. Woodward. It came from John Early; yes. 

The Chairman. It reads as follows [reading] : 

Senator Ransdeix, 

Washington, D. G. 

Dear Senator: Sunday you asked the question is there enough lepers in 
the United States to justify a national leprosarium, to the which I will answer 
through the following facts : There are about 500 known cases in the United 
States that have developed mostly within the past 10 or 15 years. Three of 
them I have knowledge of personally and was soldiers in the Philippines, and 
as far as the facts show the disease was contracted there. Therefore, we can 
readily see that leprosy is spreading in the country to an extent that calls 
forth sharp local attention and certainly should call forth national. To segre- 
gate a leprous person is wise and humane thing to do, but to let matters to 
drift on in the present road is another thing. As soon as a leper is found, 
under present conditions, he finds himself out of a home and absolutely unwel- 
come in the jurisdiction where he is found. I know of cases where the law 
has been violated by one jurisdiction shifting a leper into another. Such would 
cease under national supervision. There is a tendency on the other hand, under 
existing status, for the local doctor to refrain from reporting cases which 
would also cease under national care. Leprosy is surely a dread disease, not 
only in name, but in facts, gnawing away the vitals of the system, in time re- 
duces the strongest to apathy and helplessness. Truly he is a hard sufferer 
when all conditions are considered. Then, we ought, as a Christian Nation, 
make provision for him. Remember we are outcasts of society; yes, with 
human tastes and feelings. 
Yours, very truly, 

John Early. 

P. S. — Please pardon mistakes. I had to write in haste. 

Senator Works. That is a very good letter. 
Senator Fletcher. Yes. 



160 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. Doctor, we are very much obliged to you. I will 
ask Dr. McCoy to address the committee. 

STATEMENT OF DR. GEORGE W. McCOY, SURGEON, UNITED 
STATES PUBLIC HEALTH SERVICE, DIRECTOR OF HYGIENIC 
LABORATORY. 

The Chairman. You say you have recently been the director of 
the United States leprosy station in Hawaii? 

Dr. McCoy. Yes, sir; director of the United States leprosy in- 
vestigation station in Hawaii. 

The Chairman. You were there last, when? 

Dr. McCoy. I left there about three months ago. 

The Chairman. Did you spend much time in your investigation 
of the disease? 

Dr. McCoy. I spent about four years studying leprosy in Hawaii. 

The Chairman. Did you live there for four years? 

Dr. McCoy. Yes, sir. 

The Chairman. Studying leprosy? 

Dr. McCoy. Yes, sir. 

The Chairman. You think you have investigated the disease as 
thoroughly as you could possibly do so in that length of time? 

Dr. McCoy. I tried not to waste any time. 

The Chairman. Naturally. 

Senator Fletcher. How many cases did you have there, Doctor? 

Dr. McCoy. We have about 650 to 700 known lepers. When I 
left there were, as I recollect, about 680. Most of them were in 
the Molokai settlement. 

Senator Works. Is there a compulsory law there ? 

Dr. McCoy. A very rigid law, which the Territorial courts have 
sustained. 

The Chairman. Give us an idea of that law, Doctor? 

Dr. McCoy. The law, in general, provides that when any person 
is suspected, either by himself or by another person, of being a 
leper he may call upon the board of health to give him an official 
examination by not less than three physicians. If they agree on 
the diagnosis he is immediately officially committed by the board of 
health to the leprosy station and remains there until released by the 
board of health or until the case terminates. If the individual does 
not see fit to present himself voluntarily, the law provides that a 
court may issue a warrant for his arrest, and he may be brought 
before a court, which will order an examination by three physicians. 

In the four years in which I was intimately connected with the 
commitment of lepers there was not a single instance in which the 
issuance of a warrant was required. Practically every leper came 
forward voluntarily or upon request when information was given 
by a physician or by some other person. 

The Chairman. Why did they come forward voluntarily? 

Dr. McCoy. I think perhaps the chief reason was that they knew 
they would be compelled to come by the board of health by opera- 
tion of the law. 

Senator Works. So far as the court proceeding is concerned, it 
seems very much the same as proceedings relating to the insane. 



S. Doc. 306, 64-1. 




ANAESTHETIC LEPROSY, TYPICAL CASE. 
Note the patches in which the patient has lost sense of feeling. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 161 

Dr. McCoy. I judge so. I am not acquainted with that. I think 
it is only fair to say that there are some cases in which the indi- 
vidual is undoubtedly actuated by a feeling that to come forward 
voluntarily is a duty which he owes to the community in order that 
it may be determined whether he is a leper or not. 

The Chairman. They are treated kindly and comfortably, are 
they, there, Doctor? 

Dr. McCoy. Very. The Territory of Hawaii has done itself 
proud in the care and treatment of lepers, and there are very few 
people who realize what a tremendous social and financial burden 
it has been to the Territory. The cost is about $200,000 a year. 

The Chairman. You say the treatment is very humane? 

Dr. McCoy. Very humane, yes. There is nothing that, humanly 
speaking, could be provided for them that is lacking. 

Senator Fletcher. These cases all originated there, did they not? 

Dr. McCoy. Practically all of them originated there, yes. Hawaii 
is one of the world-famous foci of lepers. 

The Chairman. It has only existed there since 1838, I think. 

Dr. McCoy. The dates are somewhat conflicting on that. The 
first recognized leper, one recognized beyond any reasonable ques- 
tion, was about the year 1849. 

The Chairman. Dr. Blue, of your service, said, several years ago, 
that the first known cases were in 1838. 

Dr. McCoy. There is a lot of conflicting opinion in regard to when 
it started and as to where it came from. But I think it has become 
the consensus of opinion that it was brought in by the Chinese. 
Probably they carried it into Cuba and into some of the Pacific 
islands other than Hawaii. In California the cases are very largely 
of Chinese origin, too. 

Senator Fletcher. Have you satisfied yourself as to the causes of 
leprosy, whether they are traceable to diet or what ? 

Dr. McCoy. The way leprosy is carried from one person to an- 
other is a matter about which no one knows anything with certainty, 
practically speaking. We do know that it is a contagious disease, 
but we do not know how it is carried. There is no evidence that 
diet has anything to do with it. 

Leprosy first attracted serious attention in 1864 in Hawaii, and a 
settlement was established in that year and has been in operation 
ever since — a little over a half century. 

Senator Works. What was the occasion for that? Did it appear 
in epidemic form ? 

Dr. McCoy. It appeared to spread rapidly among the natives. The 
spread of the disease in Hawaii has been very largely among the 
natives. Comparatively few people of other nationalities have de- 
veloped it. Outside of those of native blood the largest number 
afflicted is among the Portuguese. 

Senator Fletcher. What observation have you made in regard 
to the duration of the disease ? 

Dr. McCoy. You mean how long the individual usually lives ? 

Senator Fletcher. Yes, sir. 

Dr. McCoy. That varies. The shortest period I have seen is about 
three years. Some cases last as long as 30 years or even longer. 
There are lepers at Molokai who have been there not far from 30 
years. The average is about 10 years. 



162 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Senator Fletcher. Do any of those who put into this station 
ever come out ? 

Dr. McCoy. Oh, yes. I served on nearly all of the examining 
boards while I was in Hawaii, and we released nearly 40 people in 
the four years I was there. It is a comparatively small proportion 
of those in the settlement. 

Senator Fletcher. Have you any instances where it subsequently 
developed and they conveyed it in any way ? 

Dr. McCoy. There is no instance of where they are known to have 
conveyed it. There have been very few instances — only one, I be- 
lieve, in my experience — where the disease reappeared. All those 
released as " cures " would remain somewhat under suspicion. We 
Avould not feel entirely safe about a person who once had leprosy, 
because it is a disease that is prone to recession and aggravation. 
However, extremely few have ever come back again after being re- 
leased. 

Senator Works. I suppose they are submitted to a certain exami- 
nation upon being released? 

Dr. McCoy. Yes, sir; the board of health has regulations which 
require those who are released to report not less frequently than once 
in six months for further examination; so the community is very 
well protected in that respect. A board of three physicians examines 
him. If a leper wants to waive his right to a full board of three 
physicians for admission to the hospital, he may do so ; that happens 
sometimes; but a person must be examined by three physicians when 
he is released. 

The Chairman. Will you describe the disease as to the cause, the 
symptoms, etc.? Tell us something about the disease. That is a 
question that has not been gone into by any of the witnesses. 

Dr. McCoy. All right ; if I draw it out too long, choke me off. 

The Chairman. I do not think you can make it too long. We want 
it rather fully. 

Dr. McCoy. There are many interesting facts in connection with 
leprosy. In the first place, there are only a limited number of peo- 
ple in any community who are infectable — that is, who could possibly 
get leprosy. The experience in Hawaii shows rather clearly that 
even under conditions of most intimate association — where a man is 
living with his wife, for instance — not to exceed 5 per cent of the 
people will be infected. In the ordinary run of the native popula- 
tion in the Hawaiian Islands, it seems that about 2 per cent will 
acquire leprosy. That is not a very high figure for a contagious dis- 
ease, but still that is the fact. In New Caledonia, a French posses- 
sion in the South Seas, at one time almost 5 per cent of the popula- 
tion had leprosy. 

The Chairman. You say there are, perhaps, 5 per cent of the peo- 
ple of New Caledonia afflicted ? 

Dr. McCoy. Yes; there were. 

The Chairman. Is that where they are thrown into most intimate 
connection — living together as husband and wife? 

Dr. McCoy. Yes, sir; living together in the most intimate rela- 
tions. Five per cent of the persons is about the maximum. 

In this connection I would like to insert some data with reference 
to the danger of associating with lepers at Molokai. 



S. Doc. 306, 64-1. 




TUBERCULAR LEPROSY, TYPICAL CASE. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 163 

(The matter referred to is here printed in full, as follows :) 

The Danger oe Association with Lepers at the Molokai Settlement. 1 

[By George W. McCoy, Surgeon, Director Leprosy Investigation Station, and William J. 
Goodhue, M. D., Medical Superintendent, Territorial Leper Settlement, Molokai, 
Hawaii.] 

We have collected from the available records all of the data having a bearing 
upon the risk of infection incurred by healthy persons living at the Hawaiian 
leper settlement at Molokai. This has been supplemented by personal observa- 
tion and by catechizing old residents of the settlement. 

The evidence concerns adults only. The duration of the contact was from 
a few months to many years. On account of the long incubation period of 
leprosy no case has been considered that came to the settlement since 1908. 

For convenience of classification and to emphasize the nature of the associa- 
tion we have divided the contacts into two classes : First, the " kokuas," or 
clean persons, who have lived with lepers, usually in conjugal relationship; 
second, other persons, including members of nursing and religious orders, all of 
whom lived in less close association with the inmates than did the kokuas. 

The kokuas. — The word " kokua " is a Hawaiian term for which there is no 
exact English equivalent. Perhaps the nearest translation would be helper, 
but it means rather more than this and is employed almost exclusively to 
designate a person who has voluntarily gone into isolation at the settlement 
for the purpose of affording aid and companionship to a leper, usually the 
husband or wife, sometimes another relative, rarely a friend. The kokuas are 
practically all Hawaiians or part Hawaiians. 

The Territorial board of health is authorized by law to permit a clean adult 
to accompany a leper to the settlement when the circumstances appear to war- 
rant it. Upon the death of the leper or for other reasons the kokua may leave 
the settlement after a physical examination to determine freedom from leprosy. 
It frequently happens that the person remains and marries another leper. 
There are several kokuas now living in the settlement who have been married 
in succession to three lepers, and one clean woman has at present her fourth 
leper husband. We may remark here that usually these kokuas have no dread 
of becoming infected with the disease; indeed, the majority of them would 
welcome being declared lepers, since then they would no longer fear being 
required to leave the settlement, an occasional occurrence caused by insubordi- 
nation. 

The data are shown here in tabular form : 

Male kokuas. 

Married to lepers (developed leprosy, 5) 98 

Type of disease of wife: 

Nodular 46 

Mixed 39 

Anesthetic 48 

Total number of wives 133 

Living with lepers other than wives (developed leprosy, 0) 21 

Total number of male kokuas (developed leprosy, 5) 119 

Of the 5 who developed leprosy, 2 were the husbands of nodular cases, 2 of 
the mixed type of the disease, and 1 had been married twice, the first wife 
being a nodular case, the second an anesthetic one. 

It will be observed in the above table that the total under type of disease of 
wife (133) is greater than the total number of kokuas. The reason, of course, is 
that some of the men were married more than once. The same explanation 
applies to the table following. 

i Public Health Bulletin No. 61, U. S. Public Health Service, 1913. 



164 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Female kokuas. 
Married to lepers (developed leprosy, 4) 83 

Type of disease of husband: 

Nodular 47 

Mixed 27 

Anesthetic 42 

Total number of husbands 116 

Living with lepers other than husbands (developed leprosy, 1) 23 

Total number of female kokuas (developed leprosy, 5) 106 

Of the 5 women who developed the disease, 1 lived with her son, who had 
leprosy of the mixed type, and the other 4 lived with their husbands. The hus- 
band of 1 had the nodular type, of another the mixed type, and of a third the 
anesthetic type. One had two husbands, the first a mixed case and the second 
an anesthetic one. 

Of the 10 persons who developed the disease in the settlement 1 was diagnosed 
three years after arrival, 1 five years, 1 seven years, 1 eight years, 2 twelve 
years, and in the case of 4 this point could not be ascertained. These periods 
are, however, of no particular significance, as in every case the person had lived 
with the leper before coming to the settlement. 

The type of leprosy developed was as follows : 

Nodular 1 

Mixed 3 

Anesthetic 1 

In the case of 5 the type could not be learned. 

The kokuas considered here have remained in the settlement from a few 
months to many years, some of them developing the disease after leaving. 
Twenty-one came in between 5 and 10 years ago. None of these have become 
lepers. 

It is quite obvious that small as the percentage is of those who have devel- 
oped the disease it is not fair to charge all of these cases to infection in the settle- 
ment, as it is reasonable to suppose that some of them (possibly all) were in- 
fected outside. It is very difficult to determine the incidence of the disease 
among Hawaiians in general, but probably at least 2 per cent of the general 
native population of the islands develops leprosy, therefore the percentage (be- 
tween 4 and 5 per cent) of those who come to the settlement clean and develop 
the disease is not so high as might be expected. 

Contacts other than kokuas. — The members of this group are all Caucasians 
and include priests, Franciscan sisters, brothers of the Order of St. Francis, and 
others whose association with lepers is of a similar nature. They come into 
intimate contact with diseased persons in nursing them, in applying dressings to 
surgical cases, etc. They do not at present live in the same houses with the 
inmates of the settlement ; indeed in most cases lepers are prohibited entering 
the houses of these clean persons. It is understood that in earlier years some 
of these persons were quartered in the same buildings with lepers. In this 
group there were 12 women, none of whom developed leprosy, and 23 men, 3 of 
whom acquired the disease — a priest (the well-known Father Damien), a brother 
of the Order of St. Francis, and 1 other person. The time that elapsed after the 
beginning of their association with lepers and the appearance of the disease 
was as follows : In one case 3 years, in another 9 years, and in the third 17 years. 

SUMMARY. 

Of 119 men, practically all Hawaiians or persons of mixed Hawaiian blood, 
living in the same house with lepers, 5 (4.20 per cent) developed leprosy. 

Of 106 women, practically all Hawaiians or persons of mixed Hawaiian blood, 
living in the same house with lepers, 5 (4.71 per cent) developed leprosy. 

Of 12 women, all Caucasians, who lived in such contact with lepers as is neces- 
sary in administering to their bodily and spiritual needs, none developed the 
disease. 

Of 23 men, all Caucasians, who lived in such contact with lepers as is neces- 
sary in administering to their bodily and spiritual needs, 3 (13 per cent) de- 
veloped the disease. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 165 

So far as we could ascertain the shortest period in which the disease developed 
after the person entered the settlement was 3 years (2 cases) and the longest 
17 years. 

Mention should be made of the fact that in some of the earlier reports from 
the settlement we find it stated that a very large percentage of clean persons 
became lepers ; thus in a report made in 1S86 it is asserted that 17 of 178 kokuas 
became lepers in 1 year, and in another, made in 1888, that 23 of 66 kokuas 
examined had become lepers. Whatever may have been the facts in the early 
days of the settlement it is certain that no such state of affairs exists at the 
present time. It is just possible that the improved general sanitary conditions 
under which the settlement has been operated in recent years may have lessened 
the risk of infection. 

The Chairman. Have you studied the disease elsewhere than in 
Hawaii ? 

Dr. McCoy. I have ; not directly, but through the literature avail- 
able. 

The Chairman. Through the literature? 

Dr. McCoy. Yes ; there is a good deal of literature on the subject. 

.To return to the disease: Leprosy usually begins comparatively 
early in life, yet it is not a disease of the very young. Most cases 
occur between the ages of 15 and 30. 

It is one of the most remarkable facts that it does not affect the 
two sexes equally. The world over, there are practically two male 
lepers for one female. No one can explain this, but it is a fact. I 
have here an article in regard to the fecundity of Hawaiian lepers, 
which I believe would be of interest to the committee. 

The Chairman. Please insert it, doctor. 

(The matter referred to is here printed in full as follows :) 

Fecundity of Hawaiian Lepers. 1 
[By -George W. McCoy, surgeon, Director Leprosy Investigation Station.] 

The birth rate among lepers is generally assumed to be much lower than that 
of the healthy population living in the same country. That this view is widely 
held is shown by the following quotations from standard authorities : 

Morrow, in the Twentieth Century Practice of Medicine, 2 says, " One recog- 
nized effect of leprosy, especially in the tubercular form, is its inhibitory in- 
fluence upon procreative power. This is doubtless due to the azoospermia, 
which is especially marked in the advanced stage of the tubercular form, 
although the sterility of leprous marriages is not so pronounced as has been 
generally assumed," and in another place in the same article (p. 430) he states 
that " Sterility is a common result of marriages among Hawaiian lepers." 

Manson 3 says : "Another powerful argument against the doctrine of heredity 
is the circumstance that lepers become sterile early in the disease." 

Scheube 1 states that "The sexual functions of the patients are soon dimin- 
ished or extinguished." 

While engaged in work at the Molokai settlement the writer has been im- 
pressed by the number of births that occurred among lepers ; therefore a study 
has been made of the birth rate for the period for which reasonably accurate 
figures were to be obtained B and a comparison made with the general birth rate 
of the Territory. 

It was found that no statistics of value in the present connection were to be 
obtained for any year earlier than in 1900. The result of the study of the data 
is presented here in tabular form. In the first section of the table the figures 
are shown for all lepers and their consorts in the settlement, while the three 
following sections are devoted to the grouping of cases according to whether one 
or both parents were lepers. 

i Public Health Bulletin No. 61, U. S. Public Health Service, 1913. 

a Vol. XVIII, p. 424, W. Wood & Co., New York, 1899. 

s Tropical Diseases, Fourth Edition, p. 557, W. Wood & Co., New York, 1912. 

* Diseases of Warm Countries, Second Revised Edition, p. 245, P. Blakiston's Son & Co., 
Philadelphia. 

B The writer is indebted to Mr. J. D. McVeigh, superintendent of the settlement, for 
placing at his disposal the records from which the studies were made. 



166 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 





Total 
lepers 
and 


Total 
births. 


Birth 
rate 
Per 


Both parents lepers. 


Mother a leper; father 
not a leper. 


Father a leper; mother 
not a leper. 


Year. 


Per- 




Birth 


Per- 




Birth 


Per- 




Birth 




sorts. 




1,000. 


sons 


Total 


rate 


sons 


Total 


rate 


sons 


Total 


rate 








in 


births. 


per 


in 


births. 


per 


in 


births. 


per 










group. 




1,000. 


group. 




1,000. 


group. 




1,000. 


1900 


1,050 


16 


15.2 


940 


15 


15.9 


60 


1 


16.66 


50 








1901 


1,005 


13 


12.9 


895 


10 


11.17 


60 


1 


16.66 


50 


2 


40.0 


1902 


926 
933 


13 
17 


14.03 
18.2 


822 
843 


11 
11 


13.38 
13.04 


58 
50 


5 


34.48 
100.0 


•a 

40 




1 





1903 


25.0 


1904 


910 


18 


19.78 


802 


15 


18.7 


60 


2 


33.33 


48 


1 


20.8 


1905 


913 


17 


18.6 


803 


15 


18.68 


60 


2 


33.33 


50 








1906 


879 


23 


26.16 


777 


21 


27.02 


50 


1 


20.0 


52 


1 


19.2 


1907 


848 


16 


18.86 


748 


14 


18.7 


52 








48 


2 


41.6 


1908 


837 


15 


17.9 


745 


10 


13.4 


50 


4 


80.0 


42 


1 


23.8 


1909 


767 


20 


26.07 


679 


16 


23.56 


46 


3 


65.2 


42 


1 


23.8 


1910 


668 


13 


19.4 


560 


8 


14.2 


56 


4 


71.4 


52 


1 


19.2 


1911 


647 


13 


20.0 


537 


10 


18.6 


58 


3 


51.7 


52 








1912 


676 


19 


28.1 


568 


13 


22.8 


56 


6 


107.1 


52 








Total.. 


11,059 


213 


19.26 


9,719 


169 


17.38 


716 


34 


47.48 


624 


10 


16.02 



i 



The most accurate figures available for the birth rate of the whole Territory 
are those for the year ending June 30, 1912. During this period the rate was 
26.82 per 1,000 for a total population of 191,909, the number given by the 
census in 1910. The birth rate of native Hawaiians for this period was 24.87 
per 1,000 and that of the part Hawaiians 50.06 per 1,000. It will be seen that 
the birth rate of the settlement, 28.1 per 1,000, for the same year is a trifle 
above the general rate of the Territory and above that for native Hawaiians, 
but much under that for part Hawaiians. 

In looking over the table it will be noted that in each section there are one 
or more years in which the birth rate at the settlement is in excess of that of 
the general population or of the Hawaiian part of the population, though the 
majority are below this. In the averages of the total period of 13 years the 
only group giving a larger rate than that of Hawaiians at large is that in which 
the mother was a leper, the father a nonleper. The rate for the group in which 
both parents were lepers is approximately 7 per 1,000 less; that in which the 
father was a leper, the mother a nonleper, being approximately 9 per 1,000 
less ; and the whole rate of the settlement is approximately 6 per 1,000 less. 

Probably the chief significance of the figures, aside from the very consider- 
able number of births shown, lies in the fact that in the group in which the 
father was a leper, the mother a nonleper, the birth rate is only about one- 
third that in which the mother was a leper, the father a nonleper. 

There are certain facts that must be taken into consideration in comparing 
the birth rate in the settlement with that outside. 

Briefly these are as follows: 

(1) The birth rate given for the Territory at large is smaller than it should 
be on account of failure to report births, while all births that occur at the 
leper settlement are reported, as particular attention is paid to this matter, 
and the entire population is under constant medical surveillance. 

(2) The populaion of the settlement contains a larger proportion of adults 
than is found among the general population. 

(3) To counterbalance this latter error is the fact that in the settlement the 
proportion of adults who do not live in conjugal relation is much larger than 
in the Hawaiian population at large. Thus, in the year ending June 30, 1912, 
among 622 lepers at the settlement, 225, or 36.2 per cent, lived in the different 
institutions, i. e., the home for men, the home for women, and the home for 
aged and infirm ; while 397, or 63.8 per cent, lived outside in family relation- 



(4) Females constitute only about 38 per cent of the inhabitants of the 
settlement, while in the population at large the proportion is much higher. 

(5) Another source of error is introduced by the part-Hawaiian population. 
This element is about half as numerous as the pure Hawaiians in the Territory 
at large, while at the leper settlement it constitutes a much smaller proportion 
of the residents. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY, 167 

Even when all these sources of error are considered, it remains certain that 
the birth rate of the settlement is by no means small ; indeed, it probably falls 
not very far below the rate for the native population throughout the Territory. 

There are other factors that probably should be considered before concluding 
that leprosy per se does not exercise a very strong influence in diminishing the 
birth rate. The chief of these is the easier economic conditions surrounding 
the inhabitants of the settlement as compared with Hawaiians in general. The 
former are provided for by the Territorial government, and doubtless generally 
are better fed, better housed, and better clothed than those outside. Then, 
possibly the knowledge that any child born at the settlement will be cared for 
by the Government, while outside each family must provide for its own off- 
spring, may have an influence in raising the birth rate. 

The result of the examinations of the figures may be summarized as follows : 

(1) The birth rate of the Molokai settlement is probably about two-thirds 
as high as that of the nonleprous members of the same race outside, but the 
data for an entirely just comparison are lacking. 

(2) The birth rate among lepers appears to depend on the fertility of the 
male, which probably is materially reduced. 

(3) The fertility of the female does not appear to be impaired. 

The period between exposure and the time the disease develops 
varies very greatly. Some one said here yesterday that it developed 
sometimes between six months and two years. I think six months is 
extraordinarily low — an extraordinarily short period. Two years is 
very short. 

The Chairman. You mean after exposure? 

Dr. McCoy. Yes ; for the disease to develop after exposure. I have 
personal acquaintance with four cases which throw some light on 
this. One developed after 4 years, one after 17 years, and one after 
7 years. Another case, which was that of a very intelligent, observ- 
ing white person, developed about 30 years after her last known 
opportunity for contact with a leper. This person had at that time 
been in contact with lepers, but not close contact. 

Senator Works. You think there is no such thing as development 
of the disease in a person without contamination ? 

Dr. McCoy. No, sir. 

Senator Works. That is not possible, Doctor? 

Dr. McCoy. It seems not. I do not think so. There are no grounds 
for believing that there, is any development of the disease without 
contamination. No one ever develops leprosy spontaneously in a 
place where there is no leprosy. 

Senator Works. That is what I wanted to understand. 

Senator Fletcher. What would you call exposure? 

Dr. McCoy. That is a question difficult to answer. Simply living 
in a community where there are lepers may be regarded as exposure. 
I should like to insert in the record some data in regard to the dis- 
tribution and transmission of leprosy in Hawaii and elsewhere. 

(The matter referred to is here printed in full as follows:) 

A Statistical Study of Leprosy in Hawaii. 1 

[By George W. McCoy, Surgeon, United States Public Health Service, Director United 
States Leprosy Investigation Station, Hawaii.] 

In previous reports from this station Brinckerhoff 2 and Brinckerhoff and 
Reinecke 3 analyzed the data bearing upon leprosy in Hawaii to 1908, inclusive. 
The present paper brings the figures up to January 1, 1914, and considers some 
features not discussed in the papers mentioned. 

1 Public Health Bulletin No. 66, U. S. Public Health Service, 1914. 

2 Public Health Bulletin No. 26 : The Present Status of the Leprosy Problem in Hawaii, 
Washington, 1908. 

3 Public Health Bulletin No. 33 : A Statistical Study of an Endemic Focus of Leprosy, 
Washington, 1910. 



168 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

It is quite likely that there are errors in some, perhaps in the majority, of the 
figures given here. The records concerning leprosy in Hawaii are far from per- 
fect. There are duplications that are most difficult to detect, and though great 
care has been taken to eliminate them, some have doubtless escaped observa- 
tion. The errors that may exist in these totals and percentages are, however, 
believed to be so small that they may be disregarded. Some of the figures do 
not agree with those given by Brinckerhoff and Reinecke, probably because 
some of the data were drawn from different sources. 

Since 1909 the apprehension and detention of lepers have been conducted 
under a territorial law, which, in addition to certain administrative sections, 
contains the following: 

" Notification. — Every person who knows, or has reason to believe, that he, 
or any other person, not already under the care or control of the board of 
health, is a leper, shall forthwith report to the board or its authorized agent, 
that fact and such other information relating thereto as he may have and the 
board may require. 

" Examination. — Any person so reported, or otherwise believed to be a leper, 
may be examined at any time and place and by any physician or physicians 
that may be agreed upon by him and the board or its agent. The board or 
its agent may, however, instead request such person to appear at a designated 
time and place not less than five days thereafter and then and there to submit 
to an examination by a designated physician for the purpose of ascertaining 
whether such person is a leper. If, however, such person prefers such exami- 
nation to be made by more than one physician, he may so notify the board or 
its agent at any time before the time so designated and may at the same time, 
or within such further time as the board or its agent may allow, designate to 
the board or its agent one licensed physician ; in which case the board or its 
agent shall within five days thereafter designate to such physician a second 
licensed physician, and the two physicians so designated shall within five days 
thereafter designate to the board or its agent a third licensed physician, and if 
they fail to do so, such third physician shall be designated by the circuit judge 
of the circuit in which the examination is to be held, and in the case of the first 
circuit by the first circuit judge ; and in case such person shall fail to designate 
a physician within the time allowed, all three physicians shall be designated by 
such judge ; notice of any such designation or designations by a judge shall be 
given forthwith to such person and to the board or its agent; when the three 
physicians have been so designated, such examination shall be made by them 
or a majority of them at a convenient time and place designated by the board 
or its agent, reasonable notice of which shall have been given by the board or 
its agent to such person and such physicians. The physician or physicians who 
make the examination shall report to the board or its agent whether in his or 
their opinion such person is a leper. If such person is under the age of 16 
years, his parent or guardian, if any, may exercise such preference and there- 
after represent such person as far as may be for the purpose of this section. 
If upon such examination such person is found not to be a leper, the board 
shall furnish him upon request a certificate setting forth such fact, the date of 
examination, and the name or names of the physician or physicians making 
the examination." 

This law was made necessary by reason of the fact that the act previously in 
force had been found legally defective in certain vital points. The essential 
provisions of this law are quoted in order that it may be understood just what 
steps are taken in connection with the apprehension of a leper, and for the 
reason that it is believed by the local authorities that the number of lepers 
coming under the control of the health department in the past three years 
would not have been so large under a less effective law, although the method 
of detecting lepers is still far from perfect. It will be observed that if this 
law were obeyed there would be no trouble in having every leper isolated 
promptly. 

The first table includes the figures since the beginning of segregation in 1866 
and includes some taken from the report of Brinckerhoff and Reinecke and some 
from reports of the Hawaiian health department, but the other tables consider 
only the data for a period of 13 years, ending December 31, 1913. 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 
Table 1. — Total number of new cases. 



169 



Year. 


New 
cases. 


Year. 


New 
cases. 


1866 


141 
57 
76 
73 
31 
128 
69 
295 
53 
128 
57 
110 
136 
82 
34 
. 195 
70 
301 
108 
103 
42 
220 
558 
306 


1890 




1867 


1891 


142 




1892 ... 




1869 


1893 




1870 . . 






1871 


1895 


106 


1872 


1896 


147 


1873 






1874 




80 


1875 ... 






1876 


1900 .. 


102 


1877 


1901 


86 


1878 






1879 


1903 


121 


1880 


1904 


96 


1881 




90 


1882 


1906 


54 


1883 


1907 


94 






23 


1885 


1909 


66 


1886 


1910 


47 






109 


1888 


1912 


138 


1889 


1913 : 


49 









The marked irregularity shown in this table in the number of lepers appre- 
hended annually is no doubt due to the varying success of the efforts of the 
authorities, as there is probably no great change in the number of cases that 
develop. 

The large number of new cases shown for 1911 and 1912 requires some ex- 
planation. In the latter part of 1911 a medical man of high standing in the 
community called attention to the existing status of the leprosy problem, and 
a great deal of interest was aroused. This resulted in strengthening the hands 
of the healh authorities in dealing with the subject and indirectly gave great 
assistance in increasing the number of cases apprehended. Patients that 
physicians had regarded with suspicion were submitted to expert examination, 
and there was a more rigid enforcement of administrative measures. Fur- 
thermore, it is believed that the operation of the new law was having a favor- 
able influence and that the growth of a healthy public sentiment was bearing 
fruit. 

In the next table is shown the distribution of cases by nationalities. 

Table 2. — Nativity of lepers apprehended. 



Year. 


a 

OS 

1 

03 

w 


* . 

+a 3 
Ph 


9 
3 
o 


i> 

o 

Ph 


a> 

a 

a 

03 


o 

S3 


g 

< 


03" 

Ph 


1 
1 


3 

o 

o 

Ph 


"3 


1901 


61 
62 

64 
68 
34 
65 
15 
51 
22 
71 

29 


14 
10 

8 
12 
11 

6 
10 

2 

7 
11 
18 
28 
10 


5 
7 
9 
8 
4 
7 
4 
1 
1 
2 
4 
6 
3 



2 
6 
5 
1 
2 
6 
2 
3 
6 
7 
9 
3 


3 

3 

4 
3 
1 
4 
1 

1 
6 
2 
1 


1 

3 


1 
1 
2 
2 

3 


1 



2 
4 
2 
1 
1 
1 

2 






1 
1 


1 



1 
1 




1 

1 

2 











2 
1 
2 

2 


1 

2 


1 

1 




2 



86 


1902 


87 




121 


1904 


96 




90 


1906 


54 


1907 


94 




23 




66 




47 


1911 


109 




138 


1913 


49 






Total 


720 


147 


61 


52 


29 


14 


13 


9 


8 


7 


1,060 







170 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



The incidence of the disease among the various nationalities in the Territory 
is demonstrated in the following table: 

Table 3. 



Nationality. 



Popula- 
tion." 



Lepers, 
.901-1913. 



Propor- 
tion. 



Part Hawaiians 

Chinese 

Portuguese 

Japanese 

Caucasians (other than Portuguese) 

Porto Ricans 

Koreans 

Pacific Islanders (chiefly Filipinos) 



12, 485 
21,698 
22, 294 
79, 663 
14,684 
4,828 
4,000 
4,000 



1.36 

1.85 

1.356 

1.429 

1.2747 

1.544 

1.689 

1.500 

1.440 



i The figures for Koreans and Pacific Islanders are estimated; the others are taken from the census of 
1910. 
' United States soldiers and sailors are not included. 

It should be borne in mind that while this table shows the total number of 
new cases of leprosy during a period of 13 years, the figures for population 
are those for a single year ; hence the table does not show the proportion at 
any one time. There have been considerable changes in the number of the 
different nationalities during the period, but it is impossible to get figures that 
would serve the purpose better than those given. 

These two tables probably show a smaller number of lepers other than 
Hawaiians and part Hawaiians than have been detected, as it sometimes hap- 
pens that when leprosy is diagnosed in a foreigner, arrangements are made for 
returning the patient to his native land without making a record of the case. 

In the next table is shown the ages of lepers at the time of apprehension. 

Table 4. — Age of lepers at apprehension. 



Year. 


1 

to 
5 


6 

to 
10 


11 
to 
15 


16 
to 

20 


21 
to 
25 


26 
to 
30 


31 
to 
35 


36 
to 
40 


41 
to 
45 


46 
to 
50 


51 
to 

55 


56 
to 
60 


61 
to 
65 


66 

to 

70 


71 

to 
75 


76 

to 
SO 


81 
to 
85 


Total. 


1901 






1 



2 


3 

1 



i 

7 
7 
7 
4 
1 
5 
3 
3 

2 
10 
3 


17 

13 
23 
16 

14 
10 
9 
5 
S 
7 
19 
18 
4 


19 

15 

21 
13 

12 
10 
14 
4 
9 
12 
26 
2S 
IS 


12 

10 
IS 
16 
7 

10 
14 
4 
4 
4 
17 
23 
4 


9 
9 
IS 

11 
6 
3 

11 
2 
7 
9 

11 

IS 
3 


3 
5 

7 
2 

12 
6 
9 
1 
9 
2 

10 
8 
5 


9 

9 
4 
11 
11 
2 



10 
3 
9 

10 
3 


4 
1 
3 
4 
4 
1 
5 
1 
6 
2 
6 
5 
2 


2 
6 
7 
3 

7 
2 
1 
1 
4 
2 
5 
6 
2 


2 
2 
5 
5 
8 
1 
6 
2 
1 
1 
2 
3 
3 


1 
3 

2 
2 
3 
3 
5 

1 
1 

5 



3 
2 
1 

1 
3 
1 

1 


1 

3 
1 


3 
3 

1 

1 
1 

1 

1 

1 
1 
1 
1 






1 






1 









1 









4) 



1 
















1 




86 
87 
121 
95 
90 






1904 




1906 




94 
23 
65 


1908 








109 
138 
49 










8 


56 


163 


204 


143 


114 


79 


89 


44 


48 


41 


26 


IS 


18 


3 


3 


1 


1,058 





No age was given in 2 cases. 

About half of the total number of lepers (510 of 1,058) occurred between the 
eleventh and twenty-fifth years, both inclusive, and over a third of the total 
367 of 1,058) were persons in the second decade of life. 

One of the remarkable facts about leprosy and one for which there is no 
satisfactory explanation is that the incidence of the disease, practically every- 
where, is almost twice as high among males as among females. In the follow- 
ing table the sex for different ages is given; it will be noted that this pre- 
ponderance of males exists throughout except at the extremes of life, where the 
numbers are too small to be of significance. 



TREATMENT OF PEBSONS AFFLICTED WITH LEPEOSY. 
Table 5. — Sex incidence for different ages. 



171 



No. 

age 

given. 



Male.... 
Female. 



The civil state of lepers apprehended is shown in the next table ; as is to be 
expected, the majority are single. The disease usually attacks those who are 
below the age when marriage is contracted. 

Table 6. — Civil state of lepers apprehended. 



Year. 


Married. 


Single. 


Widow or 
widower. 


Divorced. 


No infor- 
mation. 


Total. 




26 
35 


51 

55 
75 
61 
42 
34 
49 
17 
33 
29 
72 
78 
31 


4 
2 
7 
10 
4 
3 
6 

4 
5 
1 
2 





1 

1 



2 






5 
2 
3 
3 
5 
6 
3 

1 



1 


86 












22 










11 
36 
6 
26 
13 
36 
58 
17 






































352 


627 


48 


4 


29 


1,060 





In making a study of the records to determine what association with lepers 
is reported one realizes that the sources of errors are extremely large. In a 
country where leprosy is as prevalent as it is in Hawaii a very large propor- 
tion of the population unknowingly may, and probably do, come in contact 
with the disease. It is also probable that when the history is being taken 
any association would often be concealed, as the person being interrogated 
would believe that the admission of his association with a leper would con- 
tribute to making a positive diagnosis in his own case. The figures indicate 
that association with lepers is admitted in nearly 37 per cent of all cases (391 
among 1,060), and that the presence of the disease in a parent or a brother or 
sister constituted over half of the acknowledged associations. Where multiple 
association was mentioned the case was classified under the nearest relative. 

The statement so frequently made that prolonged and intimate contact with 
leprosy is needed to bring about infection is certainly not borne out by the facts 
in Hawaii. Cases are all too frequent in which there is absolutely no history 
of any association with lepers, and this is true in some cases where the state- 
ment of the patient can be verified by reliable collateral evidence. 



172 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The acknowledged associations are shown in the following table: 
Table 7. — Association with lepers before apprehension. 



Year. 


1 

O 


1 

1 

& 

1 
O 


•a 

1 

o 


2 

o 


i 

£ 
3 

■s 

c 
o 

ESQ 


d 

c3 
O 

£ 

a 


i 
1 


.9 

a 

a 


13 

a 


a 
o 

ft 

ft 


■a 

g 

§ 


| 

I 

o 
O 
o 


o 


p 

O 

1 
o 


"3 
2 

1 



1901 


5 

4 
15 
12 
12 

4 
14 

5 
13 

6 
10 
12 

5 





o 




1 
1 





2 
2 















1 




1 

12 
11 
7 
8 
5 
1 
4 
9 
20 
16 
5 




2 
1 
1 
2 
1 



1 

2 
1 



4 
2 
1 
1 
2 
4 
1 
1 

2 
4 
2 









1 
1 

1 




1 






2 
5 

2 
1 
1 



1 

3 
1 
2 


1 


5 
6 
4 
5 
4 


7 
12 
22 
5 


1 

2 
2 

2 
1 








2 
3 
3 

3 

7 

2 
2 
4 
2 



1 

1 
7 
8 
3 
3 
2 
1 
31 

5 
7 
1 


12 
17 
51 
42 
33 
27 
42 
10 
52 
25 
59 
70 
21 


74 
70 
70 
54 
57 
27 
52 
13 
14 
22 
50 
68 
28 


86 




87 


1903 


121 


1904 


96 


1905 


90 






1907 


94 






1909 


66 






1911 


109 


1912 


138 


1913 








Total 


117 


6 


1 


102 


12 


21 


4 


18 


71 


8 


28 


70 


461 


599 


1,060 





1 Helper of a leper. 

The occupations of persons segregated were given in a little over one-sixth 
of the cases, chiefly in later years. Those that were recorded are tabulated 
here: 

Table 8. 



Occupation. 


Males. 


Females. 


Total. 




il 
2 
5 
7 

10 

6 
7 
2 


61 
3 
5 

12 




3 


2 



57 
1 













8 




7 
















7 








57 
















12 






Total 


121 


63 


184 







1 The writer is acquainted with two cases not included in this total 
persons who were employed at the settlement. 



which the disease developed in 



The length of time that symptoms have existed before the patient comes under 
the control of the health authorities is probably a very important matter in 
determining the success or failure of segregation. In this case, also, it is 
probable that false and misleading answers would often be given. While we 
are not acquainted with the mode of transmission of the disease and do not 
know at what time in its course it is infectious, there is no reason for doubting 
that the early stages are at least as dangerous as the later ones. It should 
be borne in mind, in considering the length of time the disease has existed be- 
fore the apprehension of the patient, that an early diagnosis of leprosy is often 
difficult and sometimes impossible. Nor is the difficulty confined to earl^ cases, 
as the following example will show : The writer recently had occasion to 
examine two persons who had been inmates of the Molokai settlement for a 
number of years for the purpose of determining whether any signs of the 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



173 



disease could be detected. In one case the microscopical examination of 
smears made from five doubtful lesions was negative, while the sixth, also from 
a doubtful lesion, ' showed acid-fast bacilli in considerable numbers. In the 
second case three examinations were made at intervals of several months; 
the first and second were negative, while the third resulted in the finding of 
characteristic organisms at the site of an old lesion. These were both cases 
which clinically gave only trifling evidence of skin lesions and none whatever 
that would, under ordinary circumstances, have been regarded as suspicious 
of leprosy. 

Table 9. — Duration of disease before apprehension. 



Year. 


than 
year. 


1 
year. 


2 
years. 


3 

years. 


4 
years. 


5 

years. 


6 

years. 


7 
years. 


8 
years. 


9 

years. 


10 

years. 


More 

than 

10 

years. 


A 

life- 
time. 


1901 


8 
13 
16 
17 
11 
10 
23 
3 
2 
14 
18 
40 
13 


5 

16 
14 
19 
12 
7 

12 
3 
1 
5 
22 
11 
4 


6 
14 
6 
10 
6 
7 
4 
1 

7 
16 
17 
5 


9 
4 

13 
8 
6 
6 
6 
5 

5 
8 

16 
6 


3 
2 
6 
2 
3 
2 
9 
2 
3 
1 
5 
6 
4 


2 
2 

7 

5 
3 
2 


1 
7 

10 
3 


3 
1 

3 
2 
2 

1 




1 

3 
5 
4 


4 
3 

6 
2 


1 



1 

2 
5 
3 


6 
1 
2 

1 
1 

1 

1 
1 
4 
5 



1 

2 
1 
1 

1 
1 



1 

2 




3 
1 

8 
2 
3 
2 
1 


1 
2 
5 
3 


4 
3 
2 
5 

12 

1 
1 
1 
1 
6 

10 
3 


2 














1905 


5 











1908 










1910 


1 




3 


1912 


1 













188 


131 


99 


92 


48 


42 


26 


27 


23 


10 


31 


49 


20 







A number gave no information on this point. 

The claim that the disease from which the patient suffers has existed from 
infancy is sometimes made for the purpose of misleading the examiner. This 
probably accounts for practically all in the last column. 

The following table shows the percentage of lepers apprehended who have 
had the disease less than two years : 

Table 10. 



Year. 


Less than 
2 years. 


Total 
number 
isolated. 


Per- 
centage. 




13 
29 
30 
36 
23 
17 
35 
6 
3 
19 
40 
51 
17 


86 
87 
121 
96 
90 
54 
94 
23 
66 
47 
109 
138 
49 


15.1 








24.8 




37.5 




25.5 




31.5 




37.2 




26.1 




4.5 




40.4 




36.7 




37.0 




34.7 








319 


1/060 


30.1 







It is encouraging to note that in recent years the percentage of lepers who are 
apprehended early in the disease is in general larger than in the earlier years. 

The question of how much weight should be given to the clinical symptoms 
alone in making a diagnosis is one that arises so frequently that the data have 
been examined for the purpose of determining how often clinical signs were 

33993°— S. Kept. 306, 64KL 12 



174 



TREATMENT OF PEESONS. AFFLICTED WITH LEPROSY. 



positive, while the microscopical examination resulted negatively. The follow- 
ing table gives the result of the tabulation : 

Table 11. — Finding of bacilli at official examination. 



Year. 


Positive. 


Negative. 


No infor- 
mation. 


Total. 


1901 


55 
78 
117 
90 
88 
51 
91 
22 
36 
33 
105 
118 
45 


12 
6 
2 
2 

3 

1 
1 
7 
3 

20 


19 
3 
2 
4 
2 

3 


29 
7 
1 

1 




1902 


87 


1903 




1904 


96 


1905 




1906 




1907 




1908 




1 909 


66 


1910 




1911 




1912 


138 


1913 








Total 


929 


60 


71 









It is believed in general that no serious harm would be done if a micro- 
scopical confirmation were insisted on in every case, at least prior to deporta- 
tion. The only exception might be pure nerve cases, in which ulceration existed. 
The law in Hawaii requires that the examining board shall declare a person 
either a " leper " or a " nonleper," but the board of health may parole any case 
that is not regarded as a menace to the public health. 

The following table gives the signs of onset in the cases in which it was 
given with sufficient definiteness to make the data of value : 

Table 12. 



Manifestations— skin lesions. 


Frequency. 


Manifestations— nerve lesions. 


Frequency. 


Spots of various sorts (macules, leueo- 


271 
23 
132 












Contraction of atrophy of hands or feet. 

Paralysis of hands, feet, or face 

Falling of hair (usually eyebrows) 

Total 






42 




13 


Total 


426 













The type of the disease at the time the patients were segregated is shown in 
the following table. It is often a matter of some difficulty to decide under 
what type a given case should be classified when the patient is before one, and 
obviously it is much more difficult to classify cases when one is limited to the 
data found in the records of the examination: 



Table 13. — Type of leprosy segregated, by years. 



Year. 


Anaes- 
thetic. 


Nodular. 


Mixed. 


Not 
given. 


Total. 




23 
31 
53 
38 
36 
10 
26 

4 

42 
18 
15 
27 

4 


25 
18 
28 
25 
20 
15 
29 
6 
7 
11 
73 
90 
37 


19 
18 
35 
26 
30 
27 
26 
13 
16 
17 
20 
21 
7 


19 
20 
5 
7 
4 
2 
13 


86 




87 




121 




96 




90 




54 




94 




23 




1 

1 
1 


66 


1910 


47 




109 




138 


1913 


1 


49 








327 


384 


275 


74 


1,060 





TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 



175 



It has been maintained frequently that the tendency to the development of the 
nerve type of leprosy is an indication of the lessening of the virulence of the 
infection in any endemic focus of the disease. The table indicates that, if any- 
thing, nodular cases constitute a larger proportion of lepers now than they did 
in the past. 

The financial burden of the Territory in connection with leprosy is very heavy. 
The following figures are taken from the report of the sanitary commission, an 
organization appointed by the governor under an act of the legislature that 
convened in 1911: 



L870 

1875 
1 180 
18 ^ 
1890 
1895 
1900 
1904 



Amount 
spent. 



$17,016.87 
29, 698. 93 
43, 740. 33 
54,131.00 
169,671.20 
116,447.46 
118,880.03 
149,325.95 



Number 
of lepers. 



1,213 
1,087 



$44.68 
39.25 
74.26 
81.65 
139. 90 
107. 12 
120.93 
150. 22 



1905 
1906 
1907 
L908 
1909 
1910 
1911 
1912 



Amount 
spent. 



$132, 250. 81 
96, 413. 56 
115,810.36 
165, 662. 85 
141,725.52 
162, 843. 58 
204,546.22 
231,778.27 



Number 
of lepers. 



$151.11 
116.39 
145. 12 
209. 43 
196.02 
265.21 
345.52 



The legislature that convened in 1913 appropriated the sum of $412,130 for 
the care of lepers, including permanent improvements, for the two years be- 
ginning July 1, 1913. 



Notes on the Study of Histories of 

Transmission. 



1 From the Standpoint of 



[By Donald H. Currie, Passed Assistant Surgeon and Director Leprosy Investigation 
Station.] 

introduction. 

The most simple method which is employed for the eradication of most com- 
municable diseases is the removal of the affected member from its healthy 
fellows. 

In the case of certain diseases among the lower animals (glanders, tubercu- 
losis, fowl cholera, etc.), this is effected by killing the diseased animal and 
destroying its carcass. 

In the case of human beings the nearest approach to this method that 
humanitarian ideals will permit is the complete isolation of the diseased person 
from his fellows until the course of illness has terminated. When we are 
dealing with typhus or smallpox, this isolation is comparatively easy to effect, 
as the separation of the sick from relatives and friends is of short duration; 
but when we attempt to employ this method in the case of a disease in which, 
like leprosy, the duration of the illness is for the balance of the individual's 
life, we meet with the resistance of friends and relatives, who, in many cases, 
prefer to take a serious risk of contracting the disease themselves rather than 
to surrender the ill to what they know means lifelong and complete separation. 

This is especially true when we are dealing with a people that only partially 
accept our teachings of the communicability of disease; especially true when 
the system of isolation appears to them to be unnecessarily complete in 
character ; especially true when we deal with a people whose loyalty to family 
and race is better developed than any abstract ideals of upholding the law for 
the ultimate benefit of all. 

In our present state of knowledge of leprosy it is difficult to see how we can 
ever hope to eradicate this disease without some form of isolation. We can not 
say just how complete such isolation must be to effect the results desired, as 
we do not know how man contracts the disease, except that he acquires it in 
some unknown manner, directly or indirectly, from some other person afflicted 
with it. But as our knowledge of transmission in other diseases has increased, 
our methods of eradication have, as a rule, not only become more effective^ but 



i Public Health Bulletin No. 41, U. S. Public Health Service, 1911. 



176 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

also more humane, and it is safe to say that leprosy will be no exception to this 
rule. 

Even in our present state of knowledge, certain countries, notably Norway, 
have developed a system of isolation which, at first sight, hardly appears strict 
enough to be termed isolation, yet this very country has practically stamped 
out leprosy by no other measures than the one referred to. On the other hand, 
in countries like Hawaii, where those apprehended are completely banished, 
absolute failure to lessen the incidence of the disease has resulted, not because 
the banishment of all cases would not eradicate the disease, but because the 
isolation is made so complete that the relatives of the afflicted refuse to comply 
with the spirit of the law and report their sick. 

In the case of Norway the cooperation of the people has been secured by 
instituting a modified form of isolation; in the case of Hawaii the cooperation 
of the people has not been secured, on account of the absolute character of the 
isolation. 

Just how completely must we isolate a leper from his fellows to make the 
latters' infection a remote possibility? An exact answer to this question can 
only be given when we have an exact knowledge of the means whereby we 
acquire the disease from those afflicted with it. 

Now that we can grow the bacillus of leprosy on artificial media, we may 
hope to be able to approach the subject of transmission by a direct method 
of study. Nevertheless, for the present at least, indirect means of studying 
the problem will continue to offer hope for its solution. 

Of these indirect methods of studies of this problem there are few which 
offer more promise in illuminating the subject of transmission than that of 
case study — the study of the histories of lepers for the few years preceding the 
first symptoms of the disease. 

It must be admitted, however, that the value of such evidence depends 
largely upon the locality. Those places where cases of leprosy are few offer a 
better opportunity than places where the reverse holds true, for the reason 
that in the former case, when we can trace a contact, of a certain character, 
with a leper several years before the disease develops in the patint whos his- 
tory we are investigating, it becomes reasonably certain that that patient con- 
tracted leprosy from the person referred to and during the contact described. 

On the other hand, when we obtain a history in a locality so badly afflicted 
with the disease that the patient knows that he or she has been in contact 
with a leper two, three, or half a dozen times, we must presume that there 
have also been many unknown exposures, which makes it impossible to judge 
just when and by what kind of contact the disease was contracted. 

It will be seen by the study of these notes that we are attempting to investi- 
gate the disease in one of the least favorable countries for such transmission 
studies, some of our cases having been exposed intimately, to their knowledge, 
several times, but even such data have their value. 

As to the accuracy of the histories themselves, this is obviously most im- 
portant in data of this character. We believe that the data we present here 
are as accurate as the average clinical history obtained elsewhere. None of the 
data presented here were given until we had thoroughly questioned and in some 
cases cross-questioned the patient after an interval of several weeks, keeping 
only those answers which were borne out by the further testimony of the 
patient. 

In this connection it is hardly necessary to point out that when the average 
patient states that he was in contact with a certain disease at a certain time, 
even though the patient may be truthful, he may have erred, usually not being 
an expert diagnostician; but from its frequency Hawaiians have learned to 
know the symptoms of leprosy fairly well, probably being as familiar with them 
as the average person of the same class in other countries is familiar with the 
symptoms of pulmonary tuberculosis. 

Another point to be borne in mind when considering these histories is the 
fear that these patients entertain that evidence of this character may be 
used to apprehend and isolate relatives and friends, now at large and known 
to the patient as suffering from leprosy. We have done all in our power to 
assure them that no such use would be made of such data, but this defect, 
of course, does not detract from the statements that they were exposed to a 
certain case at a certain time. The only way that it could influence the histories 
would be to withhold some statement bearing on an exposure, which they feared 
would be against the interest of some relative or friend. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 177 

The following histories were obtained either from patients under our care 
or from such under the care of the Territorial board of health. 

Case 1. Patient is about 18 years of age. He does not remember just how 
long he has had leprosy but knows that he had the first symptoms before he 
entered school. At the time that he sickened some ten persons were living 
with him ; three of these people had leprosy at that time. He does not know 
how long these people had suffered from leprosy but knows that they had the 
disease for several years previous to the development of his first symptom. One 
of these persons is his father who still lives in Honolulu. The other two are 
cousins. Both of these cousins have since been isolated. One of them was sent 
over to the settlement at the time the patient was. After developing the dis- 
ease the patient entered a Honolulu boarding school. He did not know of any 
leper being at this boarding school at that time, except himself. Since patient 
was isolated, however, one of his former schoolmates has been sent into isola- 
tion. This schoolmate not only attended school with patient, but slept in the 
same bed with him, sat beside him, and often played with him. All of this 
occurred, as before stated, after " Case 1 " knew that he was suffering from the 



The first symptoms patient noticed were red spots on his cheeks. Up to the 
time that he was isolated he never saw a leper that he knows of, except the 
three persons living in the same house with him. He has brothers and sisters, 
who are well; no relative other than the two cousins has even been sent to 
isolation. 

When he entered isolation he found a leper there whom he had known in 
Honolulu before the former developed leprosy, but there is no history of inti- 
mate contact with this case. He has had what he believed to be itch, but only 
after he developed leprosy. He was vaccinated while at school, i. e., after he 
developed leprosy. 

Case 2: Patient is 56 years of age; a Hawaiian of intelligence; has had 
leprosy for the last three years. His first symptoms were red spots on his fore- 
head. He gives the following history of known exposures to the disease: He 
lived in the house with his father, who had leprosy and died of this disease 
in 1886. His father suffered from this disease for three ( ? ) years previous to 
his death, all of which time was spent in the latter's residence in Honolulu. 

In 1902 patient was employed as a nurse in Hilo, Hawaii, and for the next 
four years he nursed a leper in the Hilo Hospital. He developed the disease 
himself about at the end of this nursing service, and one year later, i. e., 1907, 
he entered the Kalihi isolation station. None of his relatives were ever sent 
into isolation. None of the patient's friends were isolated previous to patient 
being isolated. Some of his friends have been isolated since he entered isola- 
tion himself. He had known persons with whom he went to school that were 
isolated afterwards, but this, of course, was long ago. When serving as a 
policeman, he sometimes had to arrest lepers. He never was sick with any 
disease other than this one, never had itch, and was vaccinated fifty years ago. 

Case 3: The patient is 18 years of age; he developed leprosy two or three 
years ago. His first symptom was white spots " all over him." At the time he 
sickened four persons were living with him; they were all well and have re- 
mained so. He never lived in the same house with a leper, but his cousin, a 
leper, lived 300 yards away from him, and the patient often visited him. 
Patient's grandmother also had leprosy before he developed leprosy ; she lived 
in the same house with the leper cousin, previously mentioned. The two men- 
tioned relatives have had the disease about six years. His cousin came into 
isolation with him, but his grandmother was not isolated until last year. 

When patient entered isolation he knew no one at Molokai ; none of his school- 
mates have ever been sent into isolation. 

He has had itch, but developed it since he acquired leprosy. He was vacci- 
nated at schood nine months before developing the disease. 

Case 4: The patient, a European, is 45 years of age. He first noticed diffi- 
culty in breathing through his nose. He had no other symptoms except this dif- 
ficulty in breathing for a period of five years, when eleven years ago spots came 
out on his body, the first one appearing on his right leg. He was isolated eight 
years ago, i. e., three years after the spots appeared. He gives the following 
history of exposures: He lived with a woman who had just previously lived 
with a man suffering from leprosy. The woman did not develop leprosy ; 
patient lived with this woman for about a year. It was about three years after 
patient ceased to live with this woman that the nasal symptom appeared. 



178 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Patient had also worked for a man in Honolulu who had leprosy and who after- 
wards died in isolation at Kalihi. 

Upon cross-examination, patient states that the man who had previously 
lived with the woman referred to and who was afterwards isolated, lived for 
some time in the same house with the patient in Honolulu, and they sometimes 
ate together. 

Patient was vaccinated as a child in Europe and again in 1901, i. e., after he 
had developed leprosy, but a year before he was isolated. 

Case 5 : Patient is 17 years of age ; developed leprosy about seven years ago. 
He remembers that his first symptom was a " little white spot," but he forgot 
where it appeared. He has never lived with a leper. None of his relatives have 
leprosy, and the only history of exposure he gives is that while attending school 
in Honolulu, when he was 8 years of age, there was a boy in the same class 
with him, who was shortly afterwards sent to Molokai. This boy sat in the 
same seat with with patient, and, to use the patient's words, " had plenty of 
sores." 

Patient has had itch, but not until after developing leprosy. He was vacci- 
nated when he was small. 

Case 6: The patient is only 12 years of age, and, therefore, his history can 
not be of much value. He does not know how long he has had leprosy. He only 
knows that his face became red and then white spots appeared on his abdomen 
and back. Three people were living with him at the time that he sickened, but 
they have remained healthy. He was isolated three years ago ; none of his rela- 
tives have ever been lepers that he knows of. The only exposure that he re- 
members was being taken once to the Kalihi receiving station, presumably to 
see some friend of his family, who had been isolated. Nothing more definite in 
the form of a history could be obtained from this child. 

Case 7: Patient does not know his exact age, probably about 18 years. De- 
veloped leprosy when a child. Remembers seeing first spots on his back and 
legs. As a child he played with a leper. He knows nothing of his parents. 

Patient was isolated nine years ago, but he does not remember how long 
he was sick previous to his isolation. He never attended school. Patient had 
an uncle sent into isolation before he could remember and, he believes, before 
he was born. Patient also had a cousin sent to isolation before he came him- 
self. He never saw this cousin until he saw him at Molokai. 

Patient had itch when he was about 7 years old and has also suffered from 
rheumatism. He has never been vaccinated. 

Case 8 : Patient is 24 years of age. He developed leprosy eleven years ago. 
His first symptoms were white spots on his buttocks. At the time that he 
sickened 14 other persons were living in the house with him, and 3 of these 
were suffering from leprosy. He was isolated in 1902, i. e., three years after 
he developed the first symptoms of leprosy. 

Patient has a grandfather, uncle, sister, and cousin who have been sent to 
Molokai with leprosy. He has friends who were sent to Molokai before he was 
sent, and other friends have been sent over since he was isolated. Some of 
these persons are former schoolmates of his. 

Patient had itch when he was 11 years old, two years before he developed 
leprosy. He was vaccinated when 14 years old, i. e., about the time or after 
his first symptoms developed. 

Case 9 : Patient is 18 years of age. He developed leprosy seven years ago, 
the first symptoms he noticed being light-red spots in his face. At the time 
he sickened six other people were living in the house with him. They were 
healthy and have remained so. He never attended school with a person whom 
he knew at that time to have leprosy, but from the boarding school he attended 
one boy was sent into isolation at the same time that the patient was, and an- 
other boy from the same institution was sent into isolation after the patient 
was isolated. 

Patient entered isolation three years ago, i. e., four years after developing 
the disease. He has been vaccinated three times, had itch after he entered 
isolation, but never before he developed leprosy. 

Case 10 : Patient is 20 years of age, of European parentage, and lived among 
good surroundings. He developed leprosy last year and was isolated three 
months afterwards. The first symptoms he noticed were red spots in his face 
and numbness of hands. 

He never saw a case of leprosy until he developed it himself. He had an 
uncle who was sent into isolation before the patient was born. Fifteen years 
before developing the disease the patient played with a boy who afterwards 






TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 179 

died at Molokai of leprosy. With the exception of the uncle and the boy- 
mentioned, no friend or relative of the patient was known to have leprosy 
before patient himself developed it, nor have any of his friends or relatives 
been isolated since the patient entered isolation. Patient sometimes went on 
fishing expeditions and during these spent nights in the houses of Hawaiians. 

Cask 11 : Patient is 69 years of age, and developed leprosy two years ago, 
entering isolation a few months later. The first symptoms that he noticed 
were " spots on his body," swelling of left ear, and numbness in hands. Patient 
has seen several lepers, but only casually in the streets of Honolulu ; knows of 
no intimate exposure, but his duties were such as to bring him in daily contact 
with many Hawaiians. He never had any serious illness up to the time he 
developed this trouble. 

Patient never had itch; was vaccinated in 1880. None of his friends or 
relatives have leprosy. 

Case 12 : Patient is 32 shears of age. He developed leprosy five years ago ; 
entered isolation two years ago. The first symptoms he noticed were a few 
spots on his back. 

None of patient's friends or relatives have ever had leprosy. He never lived 
with a leper. He has seen lepers on the Island of Hawaii, but did not recog- 
nize the' disease at that time. Some of his casual acquaintances have since been 
sent to Molokai, but no history of intimate exposure could be obtained. 

Patient never had itch; was vaccinated when a child. 

Case 13 : Patient is 50 years of age ; a well-developed case ; states she does 
not know how long she has had leprosy. She was isolated eight months ago. 
Up to about the time she sickened she was engaged in the manufacture of poi. 

Patient was vaccinated fifteen years ago ; never had itch. The patient, before 
illness, resided in a small village on the island of Molokai, some distance re- 
moved from the leper settlement on the same island, and a district that has 
furnished a considerable number of cases of leprosy. 

Case 14: Patient is 20 years of age. She always lived in Honolulu. The 
first symptoms she noticed were red spots " all over her body." Patient claims 
to have had the disease eleven months, but in this matter she evidently desires 
to avoid our knowing the facts. She was isolated nine months ago. Her sister 
died of leprosy in isolation nineteen years ago. Her grandmother and uncle 
had been sent to Molokai with leprosy. The patient " stayed sometimes at 
houses where lepers lived," and " knew lepers in the country, but all are now 
on Molokai ;" she also adds that she played with lepers when a child. She 
did not go to school with a leper that she knows of. Patient's answers regard- 
ing lepers she has known are guarded, probably due to the fear that such in- 
formation might lead to the apprehension of some of her friends, now at large. 

Patient has had itch ; was vaccinated while at school. 

Case 15 : The patient is 17 years of age, has had leprosy for seven years, and 
was isolated three months ago. Two boys with whom he went to school and 
often played with were sent into isolation before he was. He has " seen people 
taken to Kalihi with leprosy." He has always lived with his parents in Hono- 
lulu. None of his relatives have leprosy. 

Patient had itch several times before developing leprosy and was vaccinated 
when he was 6 years of age. 

Case 16 : Patient is 16 years of age ; states he became sick three months ago. 
The first symptom he noticed was the appearance of macules on the face. One 
of his sisters developed leprosy some years ago and died of it. Patient played 
with this sister while she was suffering from the disease. Patient has attended 
a certain Honolulu school ; while there one of his schoolmates was sent to 
Molokai. Besides this sister and schoolmate patient has seen " several " other 
lepers at the school he attended. He was vaccinated when small. Never had 
itch or any illness before developing leprosy. 

Case 17: Patient, 14 years of age, developed leprosy eight months ago; 
first lesions being macules on both legs, posterior aspect. 

Patient's brother developed leprosy some time ago and patient played with 
him while latter was suffering from the disease. Patient's sister is also a 
leper, developing the disease ten months before the patient did ; sister now at 
the Kalihi receiving station. Patient also has three cousins that are lepers. 

She states further that some of her friends have developed the disease and 
are now also at the Kalihi receiving station. She lived in Kauai and attended 
school there, but never saw a leper at the school she attended. Has never had 
any illness previous to developing leprosy. Has never been vaccinated. 



180 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Case 18: Patient is 14 years of age; has had leprosy two years. Disease 
began with macules on legs, just above ankles. Patient only knows of one 
exposure — and that with some doubt — a girl lived near her in Honolulu that 
patient thinks was suffering from leprosy. She played with this suspect up to 
three years ago. All of patient's family are well, and she never saw a leper 
among' her schoolmates. Patient has never had itch. She was vaccinated four 
years ago. 

Case 19: Patient is 12 years of age; both he and his brother developed 
leprosy at the same time, i. e., six months ago. First symptom patient noticed 
was a macule on left cheek. 

He does not know when, if ever, he was exposed to the disease ; none of his 
family have ever suffered from it that he is aware of. He attended school in 
Honolulu ; none of his schoolmates nor his friends have developed the disease, 
as far as he knows. 

Patient has never had itch ; he was vaccinated six years ago. 

Case 20 : Patient is 17 years of age and sister of " case 17." Developed 
leprosy eighteen months ago. First symptom noticed was a " cold," followed by 
nodular lesions of left arm. Otherwise her history agrees perfectly with the 
history given by her sister. 

Case 21 : Patient is 18 years of age ; has had leprosy for three years, the 
first symptom appearing on the left foot. Patient has one brother and one 
sister who also developed leprosy some years ago, the former having died of 
leprosy at Molokai. Also one of the patient's friends developed leprosy some 
time before the patient himself did. 

With the exception of these cases, the patients' statements are somewhat 
vague. 

SUMMARY. 

From the data gained in these few histories the following points are worthy 
of notice: 

First. A large percentage of the cases give a history of exposure to leprosy 
some time before they themselves developed the disease. Usually such exposures 
were of an intimate character. 

Second. While itch was a common disease among these cases, there appears 
to be no definite evidence that a connection existed between the occurrence of 
itch in some of these patients and the subsequent development of leprosy. 

Third. There is nothing in these histories to indicate any relationship between 
vaccination and the spread of leprosy. 

Dr. McCoy. The case I mentioned to you before, which developed 
within seven years after exposure, was the case of a man who had 
never seen a leper so far as he knew, but was a soldier who served in 
the Philippines and in Hawaii, and who doubtless had been thrown 
into contact with them without recognizing them. He returned to 
the United States and about seven years later developed leprosy. 

Senator Works. If that be true, the matter of climate, of food, of 
nutriment, would have nothing to do with the actual contracting of 
the disease, would it? 

-Dr. McCoy. Exposure seems to be the essential thing. As I have 
said, if a person is infected, the period is very long before the disease 
develops. It is very seldom under three years when these symptoms 
develop. 

The Chairman. Is it possible that climatic conditions or food 
might aggravate or alleviate the disease? 

Dr. McCoy. It is possible, perhaps, but there is nothing very defi- 
nite on that subject. Later I have something to say on the geography 
of the disease which might have a bearing on that. 

The Chairman. All right. 

Senator Works. It was rather suggested to my mind by the fact 
that some investigation, recently made in the case of pellagra, de- 
veloped the fact that the disease is developed in a person by food. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 181 

Dr. McCoy. That seems to be established in pellagra. Our own 
public health service worked that out very thoroughly, and the very 
same sort of work has been done in the case of leprosy, but it did not 
work out as due to diet conditions. 

Senator Works. It did not show that result? 

Dr. McCoy. No. Without infection a person does not develop the 
disease. 

As to symptoms of the disease. It sometimes happens that any- 
where up to one or two years a person will not have any outward 
manifestations of the disease, but will have fever every month or 
every two or three months. This does not necessarily occur, but it is 
tolerably frequent. Usually the first indication that anyone has 
been infected with leprosy is the development of spots on some part 
of the body, more often the face, frequently the hands and arms, or 
they may occur anywhere. 

The Chairman. What kind of spots ? 

Dr. McCoy. There are two general kinds. There are the red spots, 
often a little bit swollen. The other kind has just the reverse, and 
there is a blanching of the skin, a whitening and a loss of color. On 
which kind of spots appear depends somewhat the future course of 
the disease. If the red spots appear, little livid lumps rapidly de- 
veloping, it likely will be the nodular type, which is the more fatal. 
The white spots indicate generally the nerve type of the disease, 
which ordinarily stretches out through many years. You may have 
a period running up to a year or more, perhaps, during which the 
person has become apparently clean again, and then the spots come 
out once more, usually more widely distributed and larger, more pro- 
nounced. 

Senator Fletcher. Is there any scaling when these changes take 
place? ^ , 

Dr. McCoy. Not early in the development of the disease, but later 
that occurs. 

The spots grow larger, sometimes swelling and becoming very 
thick. There will be lumps all over the countenance, some of them 
as big as the last joint of the thumb, or larger. The eye brows fall 
out. It is a peculiar thing that the hair of the scalp is not affected. 
These spots come on various parts of the body. Curiously enough, 
they very seldom appear on the private organs, either in man or 
woman. The private organs and the scalp seem to be places on the 
body that are exempt. It is a very curious thing, but it is true, never- 
theless. The individual may feel relatively well while all this is 
going on. Perhaps the majority of cases won't be very materially 
affected in their general health. When taken into an institution and 
given proper food and proper care they often will even begin to gain 
in weight and feel pretty well. 

These spots, in due time, are very likely to begin to ulcerate and 
break open, the surfaces becoming bloody and pus appearing on 
them. Later the disease is likely to attack the internal organs, and 
these are cases that ordinarily prove fatal. 

To go back to the cases where the white spots are seen, I may 
say that these are usually of the nerve type, as I believe I have said 
before. They are very slow in developing. The white spots may 
appear somewhere else on the body. It is a very peculiar fact that 
these usually lack sensation. You can prick them with a pin and 



182 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

there is no sensation. The prick is not felt. Sometimes paralysis 
of the hand develops. The fingers will shrivel and bend up like a 
claw. That is the typical " claw hand " of leprosy. The nerves be- 
come involved and sometimes you can feel the enlarged nerve. These 
are symptoms of this type. These two types of cases, the nodular and 
the nerve, may occur in the same individual, making a mixed type. 

I want to mention another thing as a matter of considerable im- 
portance in connection with these two types. If our present views 
are correct as to the cause of the disease, the cause being a germ, the 
nerve type is of very little danger to the community. The com- 
municable element in this type is locked up in the nerves. There is 
nothing like the danger that there is in the other type, as was de- 
scribed here yesterday, where the patient exhales the germ and where 
it is found in his nasal secretions. 

Senator Works. Have you been able to discover any difference in 
the germs that produce these different effects, one of the nerve type 
and the other of the nodular type? The one germ, as I understand 
it, affects the nerves, and the other affects the outer portion of the 
body. Have you been able to discover any difference between them? 

Dr. McCoy. No, sir. That is one of the problems to which I have 
devoted much study and time. 

It seems there ought to be some distinction made between persons 
afflicted with the nerve type, which might be characterized as the 
benign type, and the other type, the nodular type, which is so much 
more dangerous. 

Senator Works. In your use of the word benign, do you mean to 
convey the idea that the patient who is suffering from the nerve 
type suffers less than a patient who has the nodular type? 

Dr. McCoy. Well, lepers do not ordinarily suffer very much. It 
is not a very painful disease. 

Senator Works. It is rather singular that an affection of the 
nerves would not cause pain? 

Dr. McCoy. There is very little pain in many cases. These nerve 
cases may have very severe neuralgia. Probably the nerve type is 
not very dangerous. The danger really comes from the nodular 
type, where the patients throw off the germs through the nose and 
mouth or from ulcers. 

The Chairman. What kind has Mr. Early? 

Dr. McCoy. I have never seen Early. 

Dr. Rucker. He has the nodular type, I think. 

The Chairman. The nodular type? 

Senator Fletcher. Yes. 

Dr. McCoy. The nerve cases, to which I refer as benign, live 
longest. These are the cases which give rise to the terrible mutila- 
tion which you sometimes see in lepers. Parts of the fingers drop 
off and sometimes the whole hand back to the wrist, and sometimes 
the toes are affected and parts of the foot. 

In administering a leprosy law it is well to keep in mind these 
classes of cases, and the fact that some are dangerous and some 
probably ar3 not. This is a matter which requires very close atten- 
tion. Some of those cases that are not dangerous may require com- 
mitment to an asylum as a matter of charity or they will become 
public charges. Some nerve lepers are committed in Hawaii, because 



TREATMENT OE PERSONS AFFLICTED WITH LEPROSY. 183 

they want to come and not because they are dangerous to society. 
They actually seek admission there. 

Senator Fletcher. They can not perform labor and make a living. 

Dr. McCoy. No ; they can not perform labor so as to make a living. 
Nobody wants them around to work. That is it exactly. The family 
can not support them, and they come to the leper hospital, where they 
are well taken care of. 

Does that cover the manifestations of the disease in a way that is 
satisfactory to the committee ? 
w The Chairman. I think so ; yes, sir. 

* Dr. McCoy. The disease is usually very easy to diagnose, especially 
the nodular type. The nerve cases are a little different and are not 
always easy to diagnose. Often your diagnosis has to be based on 
clinical experience. 

A good bit has been said here as to the prospect of a cure for a 
leper. During my experience in Hawaii we discharged about 40 
cases. I have been asked if I have ever seen a leper cured, and I 
have always answered that I do not know whether I have seen one 
cured or not, but that I have seen a good many get well. 

The Chairman. That is, you have seen them get to such a stage 
that the disease would not return? 

Dr. McCoy. The disease is arrested, but as to whether it will return 
or not I have not been able to say. 

The Chairman. You can not say whether treatment is curative 
or not? 

Dr. McCoy. No; the remedies we have used have been beneficial, 
but whether they are definitely curative in any case is a matter about 
which I am somewhat skeptical. 

Senator Fletcher. Have you reached any conclusions on the ques- 
tion of whether a man who has reached the age of 30 years before he 
takes the disease will be likely to live as long as one who takes it at 
the age of 15 years ? 

Dr. McCoy. For a long time I had the impression that the younger, 
or the earlier in life, leprosy appeared the more rapidly fatal it was, 
but my experience in Hawaii rather compelled me to revise that view. 
I doubt if there is much difference depending on the age of infection. 
The life of a leper averages about 10 years. It depends, of course, 
somewhat on how the patients are looked after; what provision is 
made to look after them, what food, etc. 

Now, as to the treatment of leprosy. A good many remedies are 
used. Chaulmoogra oil is probably the best. 

I would like to mention something about the surgical treatment of 
leprosy ; not that it is curative at all, but it gives relief. Dr. William 
J. Goodhue and Dr. H. T. Hollmann, in Hawaii, and Dr. A. A. 
O'Neill, in San Francisco, have been and are doing excellent work in 
the treatment of leprosy. A study of their methods showed me that 
you can do a great deal toward ameliorating a leper's condition; for 
instance, by amputating a finger which has a lot of dead bone in it ; 
or by taking off a foot which is riddled with pus pockets and stinking 
and rotten, so that you can smell it for half a block; or by removing 
disfiguring nodules. Sometimes a patient suffers from a closing of 
the larynx, so that breathing is difficult. We perform an operation 
upon the larynx, and the improvement that results from this is amaz- 



184 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

ing. Dr. Goodhue has performed a good many of such operations. 
In every case the tracheotomy tube is put in. They wear that from 
a few weeks to a few months, and then get rid of it. The larynx heals 
up, and the patient is benefited tremendously. I think that feature is 
not given so much attention as it should be given. In any such insti- 
tution as is proposed by this bill, surgical aid would be provided for. 

Senator Works. It is not curative, but it prolongs the life of the 
patient ? 

Dr. McCoy. It is not curative, no; but it benefits the patient a 
good deal. 

Senator Works. It would seem to be a question whether this is a 
humane thing to do, to prolong a case like that. Of course, from the 
doctor's standpoint, it is all right. 

Dr. McCoy. Lepers like to live just as well as other people. Life 
seems to be as sweet to them as it does to the rest of us. 

Senator Fletcher. Are they generally hopeful? 

Dr. McCoy. Not about being cured. They are, however, hopeful 
in a general way; they become philosophers and resolved to get as 
much out of life as they can. 

Senator Works. Death is no more certain for them than it is for 
the others. 

Dr. McCoy. No. 

From a study of the geography of the disease it is very curious to 
note that there are certain zones in which leprosy spreads more rap- 
idly than in other places, and there are other zones in which it does 
not spread at all. New York State has been mentioned here a good 
many times. I think it is a fact that in New York State leprosy 
shows no tendency to spread. I think that is true, generally, in the 
northern part of the United States. It does not seem to spread there 
so much as it does in the southern part of the United States. Off- 
hand, this looks like the warmer countries — the warmer climates — are 
more favorable to the disease than the colder climates; but, as was 
brought out here yesterday, Iceland has lepers, and Scandinavia has 
lepers, and has had for a great many years. The Pacific coast seems 
to be a place in which leprosy spreads very slowly, or with great diffi- 
culty. So far as I know at the present time there have been but two 
or three cases which developed in California in persons who have 
never been out of the State. Just what the facts mean no one knows. 

Senator Works. You expressed your doubts about the curative 
effect of drugs as applied to lepers. That doubt as to the effective- 
ness of drugs has been extended to others, has it not ? 

Dr. McCoy. I think so. 

Senator Works. There is less faith in drugs now than there was a 
few years ago? 

Dr. McCoy. Yes ; there is a tendency to fewer drugs. 

Senator Works. As I understand, you are now talking about pre- 
ventive remedies? 

Dr. McCoy. Preventive remedies; yes. That is the tendency nowa- 
days. 

Senator Works. I remember being on board the flagship of the 
Pacific Fleet and the surgeon asked me to go through the ship with 
him. I did. It was in ideal condition, as far as a layman could see. 
Everything was clean and in a sanitary condition. I asked him after 



TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 185 

we got through, " What drugs do you use ? " He said, " I do not use 
any drugs; I do not believe in drugs. There are only two known 
specifics for any disease." He mentioned them, and one of them was 
for a very common disease and the other one he mentioned was one 
which I knew, and which, I am sure, you would, too. I have talked 
with a number of physicians since and they have expressed that 
idea — that they have less faith in drugs and more faith in preventive 
measures. 

Dr. McCoy. The tendency nowadays is toward preventive medi- 
cine. 

Senator Works. The tendency now is to get away from medicines 
and drugs? 

Dr. McCoy. Precisely ; and to use preventive measures. 

Senator Works. " Medical practice " is pretty nearly a misnomer 
nowadays ? 

Dr. McCoy. Yes; in many instances. 

The Chairman. Physicians do give a good deal of medicine nowa- 
days, although perhaps not as much as formerly. 

Senator Works. That is because it is demanded, and not because 
the doctor wants to give it. 

Dr. McCoy. That is true, sometimes. 

Senator Works. Sometimes they give them bread pills. 

Dr. McCoy. Possibly. 

Senator Works. A Senator gave me a very interesting case not 
long ago of a patient who lived out in the country. He was not in 
a very serious condition. The doctor made up some medicine for 
him, and said, " Now, you take it at a certain hour," naming the 
hour. " Don't you make any mistake about the hour." He gave him 
the time that it should be taken and told him he thought it would 
help him. There were no drugs in it at all. But the man came back 
a little later and said it was wonderful what effect the medicine had 
on him. 

The Chairman. The effect was probably psychological. 

Senator Works. Apparently so. 

Senator Fletcher. Have you made any observations as to the 
progeny of these people, where one parent or the other is afflicted ? 

Dr. McCoy. When the Hawaiian settlement was established, chil- 
dren often were allowed to go in with their parents. Children were 
born in there. Of those children who lived in the settlements it 
was found that a comparatively small percentage developed leprosy ; 
in fact, it probably did not exceed 7 per cent. They lived there with 
one or more of their parents and under conditions where there was 
opportunity to contract the disease. About 15 years ago the Ha- 
waiian Government established a home in Honolulu for the care of 
children born in the leper settlements. The procedure now is this : 
As soon as a child is born in the settlement it is taken away within 
a few hours and put in a clean nursery, which is maintained there 
by the Hawaiian Government, and the child is kept there until it is 
anywhere from 1 to 2 years old. Then it is put in the girls' or 
boys' home, as the case may be, and taken care of by the Government 
until the girl or boy reaches the age of 18 or 20 years. The* girls 
marry usually, and the boys are put in a machine shop or something 
of that sort. Since that system was inaugurated there has been not 



186 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

one single girl develop leprosy and only one boy ; and the total num- 
ber of cases so far is almost a hundred. A good many of these chil- 
dren are still too young to show leprosy even if infected; that is, 
they have not reached the age when leprosy is likely to develop, and 
some of them may develop it yet, but the probabilities are that they 
will not. When the children are taken away at once, as they do now, 
they have very little opportunity to become infected. 

The Chairman. I infer from what you say that the disease is not 
hereditary ? 

Dr. McCoy. That is well established. 

The Chairman. That is well established ? 

Dr. McCoy. Yes. That is one of the few things that is well estab- 
lished in leprosy that you can feel perfectly sure about. 

Senator Fletcher. What does that indicate to your mind ? 

Dr. McCoy. That goes back to a very broad biological foundation. 
I shall not go into a discussion of that here, of course ; I do not think 
it necessary. Leprosy seldom develops in early life. That is true 
except in a very small percentage of cases. They don't develop it 
within the first five years. I had never seen a leper under 5 years 
of age until the last three or four months, when I saw a child 19 
months old. That was a distinct exception. 

Senator Fletcher. You say this is not a blood disease ? 

Dr. McCoy. It is not a blood disease in the ordinary acceptation of 
the term. 

Senator Works. In what way do you think the infection passes 
from one person to another? 

Dr. McCoy. That is a thing about which I have no information 
at all. I have studied it over and thrashed it out in my mind, 
and it has been thrashed out by many brighter minds, and as to that 
point we are still in the dark. 

Senator Works. There is nothing to indicate that the germ gets 
into the stomach and develops there, but the symptoms appear some- 
where else in the first stages of the disease, as you say ? 

Dr. McCoy. There is nothing to indicate that. One theory is that 
the germs get into the nose, and infection comes that way, just as in 
pneumonia and la grippe and things of that sort. That is a very 
soothing but not very satisfying explanation. 

Senator Works. I do not know anything about leprosy that is pe- 
culiarly satisfying. 

Dr. McCoy. No. 

The Chairman. Is it communicated by some sort of insect, such as 
a bedbug? 

Dr. McCoy. There are a number of advocates of that theory. We 
have done a lot of work along that line at the Hawaiian station, but 
without throwing any light on it at all. 

Senator Works. The fact that it is not a blood disease would 
rather refute that, because in that case it would enter into the blood 
and be transmitted through the system in that way, would it not ? 

Dr. McCoy. That would not have much bearing on the transmis- 
sion. 

Senator Works. You do not regard leprosy as a blood disease ? 

Dr. McCoy. We do not in the usual meaning of the expression. 

Senator Works. Of course, that would not be absolute proof. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 187 

Dr. McCoy. No, but the theory is interesting. 

Senator Works. That would strengthen the view of it. 

Dr. McCoy. Yes. 

There are a few things that came up yesterday about which I 
would like to say something if it is agreeable to the committee. 

The Chairman. Certainly. It is all very interesting. Go ahead. 

Dr. McCoy. One witness or another has brought in and discussed 
about all the leprosy foci in the world with one exception. It appears 
that the German focus has been overlooked. The history of that 
focus is very interesting as showing what may happen sometimes 
even in a highly cultured community. Along about 1870 — I am not 
sure of the date — a Russian servant girl, from one of the Baltic 
Provinces of Russia, which are badly infected with leprosy, went 
into East Prussia. She was an early leper when she went in. No 
one recognized it. She speedily became worse, and from that girl 
the first other case was the landlord of the hotel in which the girl 
worked, and then his wife. You must remember that there never 
had been any leprosy in all that region before. It ran into 50 cases, 
when it attracted the attention of the authorities. I think this total 
of 50 cases required not far from 30 years to develop — a good long 
period, at any rate. A sanatorium was established and isolation of 
the lepers carried out. Of course, the disease gradually died out 
and these lepers died off, until there are now about 8 or 10. I think 
that is the number; anyhow, it is a very insignificant number. 

That is the only focus of leprosy in the German Empire, so far as 
I know. It is an interesting example of how the disease will spread 
in such a community. 

It was mentioned here by several witnesses that cases come in and 
pass the critical inspection at our ports of entry. It is very true that 
the disease has come into the United States in this manner. In the 
first place, early cases of leprosy often have such mild and insignifi- 
cant symptoms that nothing but a most rigid examination with 
leprosy particularly in mind would serve to disclose it; and, in the 
second place, there is the long period which elapses between infection 
and the appearance of symptoms. 

The Chairman. It would be impossible to discover the disease if 
the symptoms were not present, as your last remark indicates. 

Dr. McCoy. That is so ; it is utterly impossible to detect the indi- 
vidual who had recently been exposed and infected with the disease, 
and in whom the symptoms had not appeared yet. And even in the 
other case it would require a kind of examination that would be im- 
practicable to give; that would be out of the question. 

On the question of shifting the cases from State to State and 
county to county: This is a thing that I have been brought into 
contact with a couple of times. The position taken by a gentleman 
here yesterday, that he would give the leper permission to go away 
provided the leper promised to remain away, is rather typical. A 
few years ago I was on duty in San Francisco at the Public Health 
Service laboratory there. A man came in, bearing a letter from 
the health authority of a Western State, not an adjacent State, but 
one not far away. The letter was addressed to Dr. Blue, and 'read 
something like this: 



188 TREATMENT OP PERSONS AFFLICTED WITH LEPROSY. 

" Dear Dr. Blue : I am sending you a man whom I have had under 
observation for some months, and I am inclined to suspect he has 
leprosy." 

The man was such a plain leper that you could tell him a block off. 
The man was in San Francisco and could not be shipped away. 
That was clearly shifting the responsibility from one State to an- 
other. He knew that when the man got to San Francisco, being a 
leper, he would be taken care of by the city. San Francisco was 
compelled to bear the burden of maintaining him. 

In California they have had some difficulty about shifting cases 
from one county to another. California has, in some respects, a 
very good leper law. It makes leprosy a quarantinable disease and 
requires isolation, and it imposes this duty upon the counties. The 
only county that has come forward and provided adequate accom- 
modation for lepers is San Francisco County. That big, generous 
community has provided for lepers in a most magnificent way, and 
it has accommodations for a limited number of the unfortunates, not 
to exceed 20 or 25. 

Some of the other counties in the State of California have no pro- 
vision. A few months ago when I was in California the secretary of 
the State board of health was very much concerned because some 
of the southern counties were shifting the lepers back and fourth. 
None of them had provided for taking care of the lepers. 

Senator Works. How about Los Angeles County? 

Dr. McCoy. Los Angeles County has a little building which is a 
part of the city and county hospital. A leper is picked up there and 
sent out there and incarcerated. If he feels like it he remains, and 
if not, he goes out, sometimes leaving on the same day that he 
came in. 

The Chairman. Evidently they do not guard them very care- 
fully. 

'Dr. McCoy. No; but that is not as bad as it sounds. They are 
very largely Mexicans, and as soon as a man finds out that he is a 
leper and finds out that he is going to be detained by the authorities 
and isolated, he immediately goes across the border, back into 
Mexico. 

Senator Works. It is a very nice thing to live near the Mexican 
border in that case. 

The Chairman. Are there many lepers in Mexico? 

Dr. McCoy. Yes, sir. 

Senator Fletcher. In what portion of Mexico are they? 

Dr. McCoy. They are pretty well scattered throughout Mexico. 

The Chairman. As a matter of fact, there are a great many more 
lepers in tropical and semitropical countries than there are in the 
colder countries, are there not? You started to tell us of the geog- 
raphy of leprosy, but you did not finish it. 

Dr. McCoy. What you say does not hold entirely. For instance, 
Russia has tens of thousands of lepers, and Scandinavia has had 
very large numbers of lepers, but by rather careful isolation and 
segregation the number has been reduced until it is prett}^ low now 
in Norway. Sweden has made less pronounced progress in that 
work ; her efforts in that line have been less vigorous. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 189 

The Chairman. It is perhaps due to more vigorous measures 
taken in the colder countries than in the Tropics that this difference 
in the numbers is due? 

Dr. McCoy. I think, on the whole, the Tropics are undoubtedly 
more favorable for leprosy to develop in than the colder climates, 
but there are many exceptions to that. 

The Chairman. What country has the most lepers? 

Dr. McCoy. British India. 

The Chairman. More than China? 

Dr. McCoy. There are lots of them in China, but not so many as 
in British India. In China leprosy is largely confined to the south. 

Senator Fletcher. Are there stations in British India? 

Dr. McCoy. Yes. These are on a purely charitable basis. There is 
no compulsion. In British India a law was passed which prohibits 
lepers from engaging in certain occupations, such as handling food, 
serving as house servants and nurses, and things of that sort. The 
same thing prevails in Egypt. 

The Chairman. How about leprosy among the negroes? 

Dr. McCoy. I have had no experience with them. It is very 
prevalent among the black tribes of Africa. I was interested in 
what was said here about the disease being less prevalent in Louisi- 
ana among the negroes than among the whites. 

The Chairman. That was stated yesterday. 

Dr. McCoy. Yes. I was not familiar with it. 

The Chairman. There is a great deal in Africa, is there not? 

Dr. McCoy. In Africa practically nothing has been done toward 
stamping it out, and it perhaps reaches the acme of its development 
there. 

Senator Fletcher. It is true that negroes do not have yellow fever 
so much as the whites. 

Dr. McCoy. In regard to the yellow fever, the facts are a little 
different. We know that the negroes have it as children and become 
immune, and an adult negro very rarely has yellow fever. That is 
the common explanation of why yellow fever is not so prevalent 
among the negroes. 

Senator Fletcher. How is it that the station there in Hawaii costs 
so much to maintain ? You do not require many nurses, do you ? 

Dr. McCoy. Not so many. 

Senator Fletcher. You figure that $10 a month for each patient 
would be about $6,800 a month for 680 patients, and for a year it 
would be twelve times that amount, or something like $81,000? 

Dr. McCoy. That is a question I have thought about a good deal. 
The actual cost of feeding these people is not the only large element 
by any means. The number of employees required is larger than you 
might expect, at first sight. They require in the neighborhood of 18 
or 20 nurses, a couple of physicians, a superintendent, and clean 
helpers. Lepers are peculiar in one respect; they do not want their 
food handled by other lepers. Men handling the food must be clean 
men, and the butcher must be a clean man. The cost of medical atten- 
tion is very large. It will run up to about $25,000 a year. There are 
a good many dressings, as there is a good deal of dressing required by 
ulcers. Of the $200,000 none is wasted. 
-S. Kept. 306, 64-1 13 



190 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

Senator Works. Do the physicians visiting there and attending 
these patients take precautions to avoid infection? 

Dr. McCoy. One of these physicians lives in the leper settlement 
all the time. He has, of course, a separate compound, just as the 
Federal officers have a separate compound in the settlement. 

Senator Works. What precaution do they take against infection? 

Dr. McCoy. The precautions are not very rigid. After they treat 
the lepers in a medical way, they change their clothing before going 
home. Of course, they wash their hands. They never wear rubber 
gloves, except at operations. The risk is so little, at any rate, that 
they do not feel that they are taking a risk. Attending physicians on 
lepers do not often become infected. But during the last year there 
died in England Sir George Turner, who had been a physician to the 
Pretoria Leper Asylum in South Africa. There are a couple of other 
physicians on record. There was a statement made here to the effect 
that an attendant has never contracted the disease, or very rarely. 
It is true that it is rare for attendants to become infected. Two cases 
have come under my observation. 

To go back to the shifting of cases from State to State and from 
county to county : About 10 years ago I was sent down in Virginia 
to see a leper woman and examine her. She had gone there from 
Pennsylvania. I do not know what was finally done about her. I 
was simply sent down there to make a diagnosis of the case, and I 
knew nothing more of it. 

The Chairman. What is your opinion as to the necessity for the 
passage of some such bill as this? 

Dr. McCoy. I think undoubtedly some provision ought to be made 
for these floating lepers. I am inclined to think they would welcome 
it and take advantage of it. 

Senator Works. If you take out the people already provided for 
in California, Louisiana, and Massachusetts, there are a very few 
left that can be reached — known lepers. 

Dr. McCoy. Comparatively few. I am familiar with the Cali- 
fornia situation, because I lived there for a number of j^ears, and I 
think the lepers would go to a national home. During the course of 
the hearing, Dr. Engman mentioned the situation in St. Louis. 
The hospital is full there, and if a diagnosis of leprosy was made, 
there would be no place to go. 

The Chairman. There is no adequate place for them in St. Louis? 

Dr. McCoy. No, sir. In San Francisco the hospital is practically 
full. That is not a State institution, but a city institution. A few 
months ago there was a leper in the State known to the health au- 
thorities." They did not want him. He did not apply to them, but 
the State health officer was trying to get the individual taken care 
of somewhere. The State authorities had no money. Alameda 
County provides a place very similar to the one in Los Angeles. 

Senator Works. The accommodations are very inadequate. 

Dr. McCoy. Very inadequate. This San Francisco asylum is a 
credit to the city, but it is not to be compared, so far as comfort and 
all other things go, which tend to make life bearable, to Molokai. 
At Molokai they have about 9 miles of range. In San Francisco 
they have a very restricted range, but the houses are well built and 
are comfortable. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 191 

The Chairman. Can you think of any other points, Doctor, that 
you wish to mention ? 

Dr. McCoy. No other point occurs to me just now. 

The Chairman. I will have the notes furnished you, and if you 
wish to add something, you may do so. 

Dr. McCoy. Thank you. 

The Chairman. We will now hear from Dr. Eucker. 

STATEMENT OF DR. W. C. RUCKER, ASSISTANT SURGEON GEN- 
ERAL, UNITED STATES PUBLIC HEALTH SERVICE, CHIEF OF 
THE DIVISION OF INTERSTATE QUARANTINE. 

Dr. Kucker. Mr. Chairman, I would like first of all, with the per- 
mission of the committee, to address myself to the administrative 
features of the bill. 

The Chairman. Very well. 

Dr. Kucker. These facts have not been brought up heretofore. 
First of all, I would like to speak of the bill and its provisions from 
the humanitarian standpoint. 

In the Division of Interstate Quarantine, in the Bureau of the 
Public Health Service, we are constantly in receipt of a communica- 
tion from States, from counties, from cities, and from individuals, 
relative to lepers. These lepers are a source of a great deal of 
expense, trouble, annoyance, and economic loss. But that phase 
of it is entirely overwhelmed by the humanitarian aspects of the 
case, the pitiable conditions in which these lepers find themselves. 

In an address which I delivered last summer at St. Luke's Episco- 
pal Church, in San Francisco, Cal., I said: 

There is one disease for which our horror has not abated, the suf- 
ferers from which we treat as cruelly as we treated them a score of 
centuries ago. Yes, more cruelly, for the rapidity with which news 
is now transmitted makes possible a refinement of torture far beyond 
the imagination of former days. The one disease which we still 
regard with ignorant horror, whose victims we harry, ostracise, and 
drive from place to place, whose sufferers we condemn to a purgatory 
on earth and force to drain the cup of misery to the dregs, is leprosy. 

" The foxes have holes, and the birds of the air have nests," but, like 
the Son of Man, the leper " hath not where to lay his head." In this 
broad Christian land, the continental United States, there are but 
three public institutions for the reception of persons afflicted with 
leprosy. One is in California, one is on an isolated island off the 
coast of Massachusetts, and one is in Louisiana. There is no place 
in the United States dedicated to the study of this disease, its mode 
of spread and the means of its prevention and its cure. Under exist- 
ing laws all that the Federal Government can do is to forbid the 
interstate travel of leprous persons, and, when absolutely necessary, 
to confine them at isolated quarantine stations. In the Philippines 
and in Porto Rico we maintain large leper colonies where these unfor- 
tunates may receive care and an asylum from a world wherein, as 35 
centuries ago, the rule is that " he is unclean ; he shall dwell alone ; 
without the camp shall his habitation be." In the United- States 
proper there exists no single leprosarium able to adequately care for 
all the lepers in our country. 



192 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The fear of leprosy on the part of the general public is such that 
when a person is discovered to have the disease the fact is heralded 
by the press throughout the land; people avoid his presence, even 
quitting the town in which the sufferer lives; business is injured; the 
leper subjected to all manner of indignities, and he is finally forced 
to move to some other locality, there again to be made the target of 
ignorant cruelty and abuse. It is as though they were those " others " 
who had the "trial of cruel mockings and scourgings, yea, moreover, 
of bonds and imprisonment." Is it any wonder that these unfortu- 
nates sometimes seek escape in self-destruction, or that mothers have 
poisoned their children rather than to permit them to live in disfig- 
urement and loathsomeness ? Is it remarkable that in so many towns 
there is hidden away in some garret an unhappy victim of this horri- 
ble disease, one who never sees the light of day, or a face save that 
of his nurses, waiting in the sadness and torment of isolation the de- 
liverance of death? 

And, to add to the irony of this wretched picture, how many per- 
sons are made to bear this burden of pain who are not lepers at all, 
but sufferers from other diseases which might be cured by proper 
diagnosis and treatment, which their families withhold in fear of 
social ex-communication. 

A few years ago the Surgeon General of the United States Public 
Health Service, realizing that something should be done in order to 
prevent the carrying of lepers from place to place, admitted a few 
cases to one of the quarantine stations. Here they were permitted to 
dwell in peace for several months, until a land-development company 
whose properties were located some 15 or 20 miles from the reserva- 
tion found that their business rivals were using the presence of these 
few unfortunates as an argument to induce prospective settlers to 
purchase land elsewhere. This created so much feeling that the 
entire State delegation combined in such a vigorous protest that it 
was necessary to discontinue the practice, and this protest was made 
in the face of the fact that the State in question had sent more patients 
to the place than any other State in the Union. Is this preaching of 
good tidings unto the meek, the binding up of the broken-hearted, the 
proclaiming of liberty unto captives? Is this in keeping with the 
doctrines of One who " put forth his hand and touched him, saying, 
' I will ; be thou clean,' and immediately the leprosv departed from 
him?" 

Whether it be from the standpoint of humanity, economy, or public 
health, it is our duty to create a haven wherein these tortured of body 
and of spirit may find a refuge. 

I think I need say nothing more on the humanitarian aspect of this 
question. 

From a public-health standpoint, this bill is of very great impor- 
tance. At the present time it is practically impossible to collect any 
leprosy statistics in this country that are worthy of the name. Realiz- 
ing that this bill was to come before Congress, the Surgeon General 
sent out shortly after the first of the year communications to all the 
48 States and to 600 cities. Three hundred and four cities of the six 
hundred have responded up to date, and only two of the States. The 
figures which have been given are manifestly inadequate. They do 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 193 

not even tally up with the other figures we have received indirectly 
from the States themselves. 

Senator Works. What was the nature of that communication ? 

Dr. Rtjcker. I have here a copy of the letter which was written to 
the health officer of each city, which I will read. 

The Chairman. Very well. 

Dr. Rucker. It is addressed to the health officer and reads as 
follows [reading] : 

It is desired to ascertain the reported prevalence of certain diseases during 
the calendar year 1915. 

For this purpose there is inclosed a blank, and it will be appreciated if you 
will kindly have it filled in with the information for your city and returned in 
one of the inclosed envelopes. 

You will find also inclosed a separate blank prepared for data regarding the 
number of cases of leprosy in your city. It is desired that special care be taken 
in the filling out of this blank, so that a complete census of the lepers in the 
country may be obtained. The question of the desirability of establishing a 
national leprosarium has been agitated recently by various groups of persons 
interested. It is important, therefore, that dependable information upon the 
number of lepers at present in the country should be at hand. 

As the reports asking for notified cases and registered deaths of notifiable 
diseases calls for deaths registered, as well as the cases notified, space has been 
provided that the registrar may sign the report as well as the health officer. In 
those cities where the health officer is also registrar he should sign in each 
capacity. 

The letter that was addressed to the States was practically the 
same, except that it says " States " instead of " city." 

Up until February 10, 1916, 17 States have been heard from in 
response to circulars sent to all the States, in accordance with the 
letter to which I have referred. Of these only two have told us about 
their cases. These are Michigan and Minnesota. In Michigan there 
appear to be three cases reported as present December 31, 1914, 
namely, one at Bay City, one at Big Rapids, and one at Three Rivers. 
The same three cases are reported present December 31, 1915, but the 
health officer estimates that there are at least 15 cases in Michigan. 

In Minnesota there were present December 31, 1914, 9, and 1 was 
added during the year 1915, making a total of 10. There is one case 
at Albert Lea, one at Cokato, one at Elbow Lake, one in Linden Town- 
ship in Brown County, one at Maple Bay, two in Minneapolis, one at 
Montevideo, one in Moscow Township in Freeborn County, and one 
in St. Paul. 

With the permission of the chairman, I will insert in the record a 
table showing the results obtained through the inquiries sent out. 

The Chairman. We shall be very glad to have it. 



194 TREATMENT OF PERSON'S AFFLICTED WITH LEPROSY. 

(The table referred to is here printed in full as follows:) 
Leprosy. 
[Reports by States for 1915.] 



States. 



Pre-ent 

Dec. 31, 

1914. 



Reported 
during 
1915. 



Died or 

removed 

1915. 



Present 

Dec. 31, 

1915. 



Isolated 
under 
State 

control. 



Isolated 
under 
local 

control. 



Michigan: > 

Bay City 

Big Rapids 

Three Rivers 

Total 

Minnesota 

Albert Lea 

Cokato 

Elbow Lake 

Brown County, Linden 

Township 

Maple Bay 

Minneapolis 

Montevideo 

Freeborn County, Moscow 

Township 

St. Paul 



i The Health Officer estimates at least 15 cases in Michigan. 

s "In one sense, none; in another sense, all, because we advise how these cases shall be handled." 
3 "All cases, however, are practically isolated at home or in some institution. One case is isolated on a 
county poor farm." 

To Feb. 10, 1916, 17 States have been heard from in response to circulars sent to all the States Jan. 15, 1916 — 
J. V. L. 



Dr. Rucker. Up to February 10, 1916, 301 cities have been heard 
from in response to the letters sent out to 600 cities on January 22, 
1916. These show cases in Ann Arbor, Mich. ; Chicago, 111. ; Jersey 
City, N. J.; Los Angeles, Cal. ; New Orleans, La.; New York City, 
N. Y. ; Oakland, Cal. ; Philadelphia, Pa. ; Richmond, Va. ; Sacra- 
mento, Cal. ; St. Louis, Mo. ; San Antonio, Tex. ; San Francisco, Cal. ; 
Washington, D. C. ; and Wilkes-Barre, Pa. 

With the permission of the chairman I will insert in the record a 
table showing the results of the inquiries sent out to the cities. 

The Chairman. We shall be very glad to receive it. 



TREATMENT OE PERSONS AFFLICTED WITH LEPROSY. 195 

(The table referred to is here printed in full as follows:) 
Leprosy. 

[Reports by cities for 1915.] 



Cities. 


Present 

Pec. 31, 

1914. 


Reported 
during 
1915. 


Died or 

removed 

1915. 


Present 

Pec. 31, 

1915. 


Isolated 
under 
State 

control. 


Isolated 
under 
local 

control. 


Not 
isolated. 






1 
2 




1 
1 




2 
il 

27 






1 
11 








1 








1 
6 

31 

9 


7 
( 3 ) 








1 










( 3 ) 
9 








9 






New York, N. Y 


20 


20 
1 


414 






1 










1 

1 


5 1 










1 




1 






'1 

81 

2 

1 
1 

2 

1 


'1 




















2 
2 

15 
( 9 ) 

14 




1 

2 
2 














15 


...... 

( 8 ) 










15 




( 9 ) 


( 9 ) 
14 


( 9 ) 




12 




10 i 








i 


1 

1 




1 

1 




Wilkes-Barre, Pa 










i 







1 Case died in August, 1915. 

2 Cases isolated under county control. 

3 Was a case from New York City treated by a Mount Vernon physician. 
* Cases isolated in the Hospital of Pepartment of Public Charities. 

5 Case died in March, 1915. 

6 Petained on premises on municipal hospital from Aug. 14 to Sept. 27, 1915. 
T Case came from California and was promptly returned. 

8 Case present Pec. 20, 1915; not reported until Jan. 4, 1916. 

9 Pisposition of case not reported. 

i" Case was in a Japanese who was deported after one month's isolation. 



To February 10, 1916, 304 cities have been heard from in response to 
1916.— J. V. L. 



circulars sent out January 22, 



Dr. Eucker. From the report it is safe to say that leprosy at the 
present time exists in at least all of the States except IT. Whether 
or not there are other cases can not be said. 

If a leprosarium is established, as the bill provides, it will be a 
means of getting statistics. It will take away the fear of giving 
statistics. 

The second important thing the bill will do, from the standpoint 
of the Public Health Service, is that it will prevent the interstate 
migration of lepers. 

I do not want to take up the time of the committee by repeating 
what others have said, but I will subscribe to the idea that lepers are 
driven from place to place and that they seem to desire to go from 
place to place. There is a certain psychology about this: When a 
leper has once been in the upper right-hand column of the front page 
of a newspaper he is often very anxious to get back again. We con- 
cede this to lepers as well as to people who are well. 

The Chairman. Have you any specific instances which you could 
give us where inhuman treatment has been accorded lepers ? 

Dr. Eucker. I could do it, but I think perhaps it would be better 
for me to insert it in the record when I look over my remarks rather 
than taking up the time of the committee now. 



196 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

The Chairman. Very well. That will be satisfactory. 

Senator Works. I think that fact is generally understood. 

The Chairman. I think so myself, but I would like to have some 
specific cases. 

Dr. Eucker. The difficulty of the early diagnosis of this disease 
has been brought out by the experts who have spoken, but of course 
this shows how difficult it is to apprehend these cases at the time they 
undergo quarantine or immigration inspection. 

The objection has been made that the bill would leave the entrance 
into the leprosarium entirely to the volition of the leper. I would 
invite the committee's attention to section 2 of the bill, and while I 
have no knowledge of the law, it would seem to me, as a layman, that 
it provides three methods by which people may be admitted to the 
leprosarium. 

There shall be received in the said home, under regulations prescribed by the 
Surgeon General of the Public Health Service, with the approval of the Secre- 
tary of the Treasury, any person afflicted with leprosy who presents himself or 
herself for care, detention, and treatment. 

That is the first way — upon self-presentation. 

Or he may be apprehended under authority of the United States quarantine 
acts. 

That is the second way. 

Or any prson afflicted with leprosy duly consigned to the said home by the 
health authorities of any State, Territory, or the District of Columbia. 

That is the third way. 

With the permission of the committee I will address myself for a 
moment to the second method. I will point out here the answer to 
another objection, namely, the authority for interstate transportation 
of persons, such persons being in the hands of the General Govern- 
ment. It seems to me that if this bill becomes a law Congress will 
confer this power: 

The Surgeon General of the Public Health Service is authorized, upon request 
of said authorities, to send for any person afflicted with leprosy within their 
respective jurisdictions and to convey said persons to such home for detention 
and treatment, and when the transportation of any such person is undertaken 
for the protection of the public health the expense of such removal shall be 
paid from funds set aside for the maintenance of said home or homes. 

Senator Works. There is one weakness in this bill, it seems to me, 
which will have to be covered. There is no machinery provided, no 
provision for determining the fact as to whether or not a given person 
is a leper or not. There should be some provision in the bill by which 
that can be determined. I suppose in Louisiana they have some sort 
of examination before anybody can be sent to the home. 

The Chairman. I think so. This bill says — 

or any person afflicted with leprosy duly consigned to said home by the proper 
health authorities of any State, Territory, or the District of Columbia. 

Senator Works. That is only one case. That does not cover the 
other. 

Dr. Rucker. I will ask the Senator if he thinks that the first few 
words of section 2 attend to that. It says " that there shall be re- 
ceived in the said home, under regulations prepared by the Surgeon 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 197 

General of the Public Health Service, with the approval of the Sec- 
retary of the Treasury, any person afflicted with leprosy." In other 
words, the Surgeon General, by regulation, determines the machinery 
for the admission of these people. 

Senator Works. That is all right if Congress wants to allow the 
Surgeon General to make those rules. That is a thing that, it seems 
to me, ought to be pretty carefully guarded, so we won't put persons 
in this institution, if established, who are not lepers. 

Dr. Rucker. Section 3 says: 

That regulations shall be prepared by the Surgeon General of the Public 
Health Service, with the approval of the Secretary of the Treasury, for the 
government and administration of said home and for the apprehension, deten- 
tion, treatment, and release of all persons or inmates thereof. 

In other words, Congress, by this bill, would clearly indicate 
that the machinery should be provided by such rules, to be promul- 
gated by the Surgeon General of the Public Health Service, under 
approval of the Secretary of the Treasury. 

Senator Works. The question is whether Congress will provide 
that machinery or leave it to the Surgeon General. 

Dr. Rucker. It would require a remarkably well gotten-up law, a 
very far-seeing law, that would meet all cases specifically. 

Senator Works. There could be a very simple provision for the 
examination of persons suspected to be lepers, and this might; or 
should, provide by whom this examination should be made. I am 
merely offering these suggestions in order that they may be consid- 
ered in the final framing of the bill. You want to take care of 
the lepers, and at the same time you want to be careful not to put 
people in there who are not lepers. 

Dr. Rucker. Of course there are a great many people who are 
lepers who would hardly need to be admitted to such an institution. 
Those are persons who are not dangerous and who are capable, by 
reason of their intelligence and means, to take care of themselves at 
their own homes. It would be ridiculous to suppose that every one 
of the lepers would be better off in the leprosarium than he would 
be in his own home. 

Just another word in regard to the second method I have men- 
tioned : This provides that a person may be admitted who presents 
himself, or he may be apprehended by authority of the United States 
quarantine act. There are on the statute books several acts, notably 
the act approved March 27 ; 1890, United States Statutes at Large, 
chapter 51, page 31, and the amendments thereto, and the act of 
February 15, 1893, which would grant ample authority for the ap- 
prehension of persons suffering from leprosy, either under regula- 
tions made in conformity with the act of February 15, 1893, or in 
conformity with the health regulations of the several States, which 
would be enforced in cooperation with those States. 

Senator Works. I think it would be well to incorporate those 
statutes in the record here. 

Dr. Rucker. I will prepare them and insert them. 

Senator Works. So they can be referred to in considering the 
matter further. 

The Chairman. Yes. 

Senator Fletcher. I think that is right. 



198 TREATMENT OF PERSONS AFFLICTED WITH LEPEOSY. 

Senator Works. By whom was this bill prepared ? 

Dr. Rucker. This bill was introduced by Mr. Ransdell. I don't 
know by whom it was prepared. 

Senator Works. I was wondering if it was prepared by the Public 
Health Service. 

Dr. Rucker. I do not think it was. About a year and a half ago 
I prepared a draft of a bill, which was included in an address which 
I delivered at Atlantic City, but this bill does not bear a very close 
resemblance to that bill. 

Senator Works. Perhaps the Senator himself prepared it. 

The Chairman. No, I did not prepare it. It was presented to me, 
and I introduced it. 

Dr. Rucker. I would also like to invite the attention of the com- 
mittee to the fact that the interstate-quarantine regulations which 
were promulgated May 15, 1912, have been superseded by a new set 
of regulations approved by the Secretary of the Treasury, under 
date of January 16, 1916, and which are still in the hands of the 
printer. 

Section 29 provides that [reading] — 

Common carriers shall not accept for transportation, nor transport in inter- 
state traffic, any person suffering from or afflicted with leprosy, unless there has 
been obtained from the Surgeon General of the United States Public Health 
Service or his accredited representative a permit stating that said person may 
be received under such restrictions as will prevent the spread of the disease, 
and said restrictions shall be specified in each instance, provided that, in addi- 
tion to the above, permit shall also be obtained from the health authorities of 
the States, Territories, or the District of Columbia, to or from which the 
patient intends to travel. 

Senator Works. Upon what law did you found this? 

Dr. Rucker. Section 3 of the act approved February 15, 1893, pro- 
vides that immediately after the act takes effect the Surgeon General 
shall examine the quarantine regulations of various States and mu- 
nicipal boards of health, and shall, under the direction of the Secre- 
tary of the Treasury, cooperate and aid in the enforcement and 
execution of the rules and regulations which the States and cities 
have made, and where there are insufficient regulations for the pre- 
vention of the spread of infectious or contagious diseases from one 
State or Territory to another State or Territory or the District of 
Columbia, the Surgeon General shall prepare the necessary regula- 
tions which shall be promulgated by the Secretary of the Treasury, 
and when the Secretary of the Treasury shall have promulgated such 
regulations, they shall be enforced by the State and local health au- 
thorities where they are willing so to do; but should they fail or 
refuse to enforce these regulations, they shall be enforced by the 
President. 

Senator Works. That seems to settle very well the question we 
have been in so much doubt about here, as to the right of the Federal 
Government to transport these people to particular places and keep 
them there. If the Government can enforce such regulations as that, 
they can do pretty much anything they want to. 

Dr. Rucker. I fancy if Congress will give us the machinery we 
can handle the matter. 

Senator Works. The question is whether the Federal Government 
has power to deal with the question as broadly as you indicate there. 



TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 199 

Dr. Rucker. Perhaps. There is just one thing in regard to that. 
This matter has already been tried out by the courts in San Fran- 
cisco, where it was held that reasonable regulations issued under the 
act had the force and authority of law. 

Senator Works. It is a question of whether it is reasonable or not ? 

Dr. Rucker. I think it is. If I were a lawyer, my answer Avould 
be this : If it could be proved that a person suffering from the dis- 
ease was a danger to the public health, then the regulation was good 
and sufficient. If, on the other hand, you could not prove that a 
person suffering from the disease was dangerous to the public health, 
the regulation would fall. 

Senator Works. I am inclined to agree with that if it is an inter- 
state or an international question, the Government has to deal with 
it; but if it is purely a State question the National Government has 
no more right to deal with it than I have. 

Dr. Rucker. Suppose the patient is willing to go ? 

Senator Works. That is no foundation. You can not have juris- 
diction of anybody on his request or invitation to go into a State. 
That is a State matter. That is not a matter for the Federal 
Government. 

Dr. Rucker. Has the State power to delegate any of its authority ? 

Senator Works. Not to the National Government. 

Dr. Rucker. Or to any representative of the National Govern- 
ment? 

Senator Works. No; the National Government's authority is lim- 
ited, and it can not extend it by request of a State. 

Dr. Rucker. I would like to continue that, but I do not know as 
much about it as you do. 

The Chairman. I would like to ask you a further question, Doctor. 

Dr. Rucker. Yes. 

The Chairman. Have you made any estimate as to the probable 
cost of a leprosarium ? This bill calls for $250,000. What will that 
accomplish ? 

Dr. Rucker. It would be impossible to make an estimate at the 
present time, because, as a matter of fact, the present knowledge or 
lack of knowledge as to where the leprosarium is to be located, if it 
is to be established, makes it very difficult. The location would be a 
matter to be taken into consideration in saying how much it would 
cost. The question will arise as to whether or not it will be necessary 
to purchase the land, and that will make a great deal of difference. 
There is also the question, still undetermined, as to how many 
patients we are going to have. It would seem to me that the amount 
allowed in this bill would be enough to make a proper beginning, and 
I believe that it can be administered in that way. 

At this point it might be well to refer to the economic aspect of 
the question. I believe that the concentration of these lepers in this 
way would be a great measure of economy. The overhead charges 
for the care of one leper are nearly as great as would be the overhead 
charges for the care of 50 lepers. The bill calls for $250,000. Now, 
let us suppose that that $250,000 will secure the land, erect the build- 
ings, and care for the patients therein for one year. Let us -suppose 
that the amount of money is equally apportioned between the States, 
because eventually it comes from the citizens of our country ; and let 



200 TREATMENT OF PERSONS AFFLICTED WITH LEPROSY. 

us suppose, without regard to population, that it is divided into 48 
parts. In other words, this division gives each State a little over 
$5,200 to care for its lepers for one year. In- the case of Massachu- 
setts, for example, they have 11 lepers. It would give the State of 
Massachusetts, under that arrangement, $473 for every one of its 
lepers. Dr. Parker in his testimony yesterday stated that it cost 
the State of Massachusetts $28,000 annually for the care of its lepers. 
There are 11 lepers there. In other words, it costs the State of Massa- 
chusetts $2,545 per annum for each of its lepers. There would be an 
economy, figured on this rough approximation, of the difference be- 
tween $2,545 and $473. 

Senator Works. If those unfortunates can be taken care of ade- 
quately and thoroughly by this means, I think we had better not stop 
to count the dollars. 

Dr. Rucker. I quite agree with you, sir. At the same time, the 
question of economy is one that ought to be taken into consideration 
and given some weight. Not only are the States and municipalities 
heavily taxed in order to care for these people, but they also suffer 
in other ways. We all know that the presence of a leper in a com- 
munity hurts business. When a leper was found in Bay City and 
escaped to a near-by town, business in that town practically sus- 
pended there the entire time that man was in that town. That thing- 
has not happened just once, but many, many times. 

It seems to me that the bill is a wise one, that it is absolutely neces- 
sary in order that we may have public health protection, and that we 
may fulfill our humanitarian duties toward these people, and that 
we may meet the economic aspects of the case. 

The Chairman. Do you think of any other points now, Doctor, 
that you ought to cover ? 

Dr. Rucker. I think of nothing, unless the committee desires to 
ask me some further questions. 

The Chairman. We are very much obliged to you, Doctor. 

(Whereupon, at 4.30 o'clock p. m., the committee adjourned sine 
die.) 



INDEX. 



Page. 

American Academy of Medicine, resolutions of 86 

American Dermatological Association, resolutions of 64 

American Medical Association, resolutions of 64 

Anaesthetic leper, photograph of, opposite page 160 

Analysis of national leprosarium bill 196, 197 

Article on— 

Cure of leprosy, by Dr. Dyer 28 

Danger of association with lepers, by Dr. McCoy 163 

Diagnosis of leprosy, by Drs. Dyer and Hopkins 15 

Fighting leprosy in Philippines, by Dr. Heiser 73 

Fecundity of Hawaiian lepers, by Dr. McCoy 165 

Leprosy as a national problem, by Dr. Hoffman 133 

Necessity of a home for lepers 79 

Statistics of leprosy in Hawaii, by Dr. McCoy 167 

Symptomatology of leprosy, by Dr. Fox 44 

Test of leprosy, by Dr. Fox 41 

Transmission of leprosy, by Dr. Currie 175 

Treatment of leprosy, by Dr. Heiser 31 

Bill- 
To provide national home for lepers (S. 4086) 1, 11 

To provide national home for lepers, analysis of 196, 197 

Bracken, Dr. Henry M., testimony of 48 

Chaulmoogra oil, treatment with 31, 34, 55, 71, 78, 183, 156 

Child lepers 185,186 

Climate and leprosy 125, 180, 184, 188, 189 

Communicability of leprosy 20, 21, 68, 132, 133, 162, 186, 187, 190 

Communicability of leprosy, article on, by Dr. McCoy 163 

Communication of leprosy, article on, by Dr. Currie 175 

Communication of leprosy, means of 23, 58, 60, 69, 161, 186, 187 

Conley, Dr. Walter F., letter from 78 

Cost of Louisiana Lepers' Home 25 

Cost of (estimated) National Leper Home 199, 200 

Cost of Massachusetts Leper Home 53, 54 

Crafts, Mrs. Wilbur F., testimony of 147 

Culion Leper Colony, Philippine Islands — ■ 

Description of 69, 70 

Photograph of, opposite page 69 

Cure of leprosy 26, 27, 28, 54, 55, 67 

Cure of leprosy with Chaulmoogra oil ..... v : . 31, 34, 35, 55, 71, 78, 156, 183 

Currie, Dr. Donald H., article on transmission of leprosy 175 

Danner. W. M. , testimony of 71 

Diagnosis of leprosy, article on 15 

Distribution of leprosy 13, 14, 23, 35, 36, 39, 49, 62, 85, 86, 88, 71, 97 

Distribution of leprosy in the world 71 

District of Columbia- 
John Early case in 143, 144, 145, 146, 147, 155 

Leprosy in 143, 158, 159 

Dutton, Brother Joseph, photograph of, opposite page 73 

Duration of leprosy 161. 162 

Dyer, Dr. Isador— 

Article on cure of leprosy 28 

Diagnosis of leprosy, article on 15 

Testimony of 13 

Early, John — 

Case of 143, 144, 145, 146, 147, 155, 158, 159 

Letter to Senator Ransdell 159 

201 



202 INDEX. 

Page. 

Engman, Dr. Martin F., testimony of 58 

Eradication of leprosy 37, 38 

Examination record of Hawaiian Leper Home 123, 124 

Fecundity of Hawaiian lepers, article on, by Dr. McCoy 165 

Federal Government, power to deal with leprosy 120, 

121, 152, 153, 196, 197, 198, 199, 200 

Fighting leprosy in the Philippines, article on 73 

Fowler, Dr. William C, testimony of 143 

Fox, Dr.— 

Article on symptomalology of leprosy 44 

Article on test of leprosy 41 

Fox, Dr. Howard, testimony of 38 

Fulton, Dr. John S., testimony of 82 

Hawaiian Leper Colony, Molokai — 

Conditions in 131, 132 

Cost of 189 

Description of 92,93 

Law of . 160,161 

Photograph of, opposite page 73 

Original examination record of leper 123. 124 

Statistics of 98,99 

Heiser, Dr. Victor G. — 

Article on fighting leprosy in the Philippines 73 

Article on treatment of leprosy 31 

Heredity of leprosy 186 

Hoffman, Dr. Frederick L. — 

Article on leprosy as a national problem 133 

Letter to Senator Ransdell : 142, 143 

Statistics of leprosy 100-119 

Testimony of 85 

Hopkins, Dr. Ralph, diagnosis of leprosy, article on 15 

Hounding of lepers 59, 60, 82, 83, 84, 89, 128, 129, 130, 131 

Iceland leper home 148, 149 

Incubation of leprosy, period of 61, 67, 167 

Indian Leper Asylum, Purulia, India, photograph of, opposite page 70 

Insanity and leprosy 126 

Kinds of leprosy 181, 182. 183 

Leper colonies throughout the world, list of, by Dr. Hoffman 93, 94, 95, 96 

Lepers' home, national, bill to provide 11 

Leproline, treatment with 55 

Leprosy as a national problem, article on, by Dr. Hoffman 133 

Letter from — 

Dr. Conley 78 

John Early to Senator Ransdell 159 

Dr. Hoffman to Senator Ransdell 142, 143 

Louisiana Lepers' Home — 

Cost of 25 

Cure of lepers in 34, 3£ 

Description of 22,23 

Lepers in 12 1, 122 

Number of lepers in 14. 23, 121, 122 

Louisiana, lepers' home in ( photograph ), opposite page 13 

Malokai, leper colony at. See Hawaiian Leper Colony. 

McKean, Dr. J. W., testimony of 68 

McCoy, Dr. George W. — 

Article on fecundity of Hawaiian lepers 165 

Article on statistical study of leprosy in Hawaii 167 

On danger of association with lepers 163 

Testimony of 160 

Massachusetts Leper Home- 
Cost of 53,54 

Description of 53 

Number of lepers in 52 

Photograph of, opposite page 53 



INDEX. 203 

National Lepers Home— p age. 

Bill to provide 1,11 

Cost of, estimated 199, 200 

Need..f 24,25,47,48,79,86,87,88,141,142,190,191,192 

National Leprosarium, power of Federal Government to establish 196, 197 

Necessity of a home for lepers, article on 79 

Need of National Lepers Home 24, 25, 47, 48, 79, 86, 87, 88, 141, 142, 190, 191, 192 

Negro and leprosy 126 

Nerve type of leprosy 181 , 182 

Nodular type of leprosy 181, 182 

Number of lepers in — 

Louisiana Leper Home 14, 23, 121, 122 

Massachusetts Leper Home 52 

San Francisco Leper Isolation Hospital 90 

United States 35, 39, 65, 73 

The world 72 

Parker, Dr. Frank H., testimony of 52 

Persecution of lepers 59, 60, 82, 83, 84, 89, 128, 129, 130, 131 

Photograph of — 

Anaesthetic leper, opposite page 160 

Brother Joseph Dutton, opposite page 73 

Chiengmai Leper Asylum, Siam, opposite page 68 

Culion Leper Colony, opposite page 69 

Hawaiian Leper Colony, Molokai, opposite page 73 

Indian Leper Asylum, Perulia, India, opposite page 70 

Kwangju Leper Asylum, opposite page 68 

Leper, opposite pages 45, 47 

Leper hand, opposite page 48 

Louisiana Lepers Home, opposite page 13 

Massachusetts Leper Home, opposite page 53 

Tubercular leper, opposite page 162 

Tungkun Leper Asylum, China, opposite page 70 

Power of Federal Government to deal with leprosy 120, 

121, 152-153, 196 -197, 198, 199-200 

Race and leprosy 125 

Report on national leprosarium bill 1 

Resolutions of — 

The American Academy of Medicine 86 

American Derma tological Association 64 

American Medical Association 64 

Thirteenth Annual Conference of State and Territorial Health Officers 86 

Rucker, Dr. W. C, testimony of 191 

San Francisco Leper Isolation Hospital- 
Description of 91, 93 

Number of lepers in 90 

Segregation of lepers 37, 38, 39, 56, 61, 66, 69, 70, 93, 124, 125, 153, 154, 155, 157 

States- 
Attitude of, in regard to leprosy 154, 155 

Methods of segregating lepers 157 

Methods of treating lepers 187, 188 

Statistical study of leprosy in Hawaii, article on, by Dr. McCoy 167 

Statistics of — _ _ 

The Hawaiian leper colony, Molokai 98, 99 

Leprosy, difficulty of collection 127, 128 

Leprosy, by Dr. Hoffman 100-119 

Leprosy in United States 193, 194, 195 

Surgical- treatment of leprosy 183, 184 

Symptomatology of leprosy, article on 44 

Test of leprosy 41, 61, 62, 63, 66 

Test of leprosy, article on, by Dr. Fox 41 

Testimony of — 

Bracken, Dr. Henry M 48 

Crafts, Mrs. Wilbur F 147 

Danner, W. M 71 

Dyer, Dr. Isador '. . . 13 

Engman, Dr. Martin F 58 

Fowler, Dr. William C 143 



204 INDEX. 

Testimomy of — Continued. Pa se. v 

Fox, Dr. Howard 38 

Fulton, Dr. John S 82 - 

Hoffman, Dr. Frederick L 85 X 

McCoy, Dr. George W 160 

McKean, Dr. J. W 68 

Parker, Dr. Frank H 52 

Rucker, Dr. W. C 191 

Woodward, Dr . W. C 151 

Thirteenth Annual Conference of State and Territorial Health Officers, resolu- 
tions of 86 

Treatment of leprosy with chaulmogra 31, 34, 55, 71, 78, 156, 183 

Tubercular leper, photograph of, opposite page 162 

Tungkun Leper Asylum, China, photograph of, opposite page 70 

Types of leprosy , v 1. 132 

United States — 

Distribution of leprosy in 13, 14, 39, 49, 62 

Number of lepers in..' 14, 35, 65, 73 

Statistics of leprosy in 193, 194, 195 

Woodward, Dr. W. C, testimony of 151 

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